Department of Oncology, Shandong Provincial Third Hospital, Shangdong University, Jinan, Shandong, P.R. China.
Department of Radiation Oncology, Chinese 960th Hospital of the Joint Logistics Support Force of the People's Liberation Army, Jinan City, Shandong Province, P.R. China.
Technol Cancer Res Treat. 2024 Jan-Dec;23:15330338231219369. doi: 10.1177/15330338231219369.
To compare the risk of death, tumor recurrence, metastasis, and disease progression in early-stage non-small cell lung cancer (NSCLC) patients treated with thoracoscopic surgery and stereotactic body radiotherapy (SBRT). Patients who underwent radical surgery and SBRT for NSCLC between April 2010 and November 2021 were retrospectively analyzed. Continuous and categorical variables were compared using the Mann-Whitney U and Chi-square test, respectively. Kaplan-Meier curves were used to evaluate the survival outcomes of each patient group. Cox proportional hazard regression analyses were performed to estimate the risk of death, tumor recurrence, metastasis, and disease progression. A total of 167 patients were enrolled, of whom 75 and 92 underwent SBRT and surgery, respectively. The median follow-up was 45 months (range, 4-105 months). SBRT patients were observed to be significantly older (median, 76.0 vs 67.0 years; < .001), and associated with significantly higher mortality rate (42.7% vs 26.1%, = .024). However, no significant difference in overall survival duration was seen between the SBRT and surgery groups (45.0 vs 41.0 months; = .199). SBRT patients demonstrated significantly lower rates of metastasis (12.0% vs 30.4%, = .004), and significantly longer metastasis-free survival (39.0 months vs 35.5 months, = .020). The remaining outcomes, including tumor recurrence and disease progression rates, were similar between the groups. Compared to surgery, SBRT did not significantly associate with death, recurrence, or disease progression. Kaplan-Meier curves showed significant differences in overall, tumor recurrence-free, and disease progression-free survival between the groups (log-rank < .05). SBRT demonstrated similar overall survival compared to radical surgery, and associated with significantly reduced risk of tumor metastasis. Our study thereby suggests SBRT as the best treatment option for patients with inoperable NSCLC.
比较胸腔镜手术和立体定向体放射治疗（SBRT）治疗早期非小细胞肺癌（NSCLC）患者的死亡率、肿瘤复发率、转移率和疾病进展率。回顾性分析 2010 年 4 月至 2021 年 11 月间接受根治性手术和 SBRT 治疗的 NSCLC 患者。分别采用曼-惠特尼 U 检验和卡方检验比较连续和分类变量。使用 Kaplan-Meier 曲线评估每组患者的生存结果。采用 Cox 比例风险回归分析估计死亡、肿瘤复发、转移和疾病进展的风险。共纳入 167 例患者，其中 75 例和 92 例分别接受 SBRT 和手术治疗。中位随访时间为 45 个月（范围：4-105 个月）。SBRT 患者年龄明显较大（中位数 76.0 岁 vs 67.0 岁； < .001），死亡率明显较高（42.7% vs 26.1%； = .024）。然而，SBRT 组和手术组的总生存时间无显著差异（45.0 个月 vs 41.0 个月； = .199）。SBRT 患者的转移率明显较低（12.0% vs 30.4%； = .004），无转移生存时间明显较长（39.0 个月 vs 35.5 个月； = .020）。两组间肿瘤复发率和疾病进展率等其余结局相似。与手术相比，SBRT 与死亡、复发或疾病进展无显著相关性。Kaplan-Meier 曲线显示两组间总生存、肿瘤无复发生存和疾病无进展生存差异有统计学意义（对数秩检验 < .05）。SBRT 与根治性手术的总生存率相似，与肿瘤转移风险显著降低相关。因此，我们的研究表明 SBRT 是不可手术 NSCLC 患者的最佳治疗选择。
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