Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Thorac Cancer. 2024 Aug;15(24):1779-1791. doi: 10.1111/1759-7714.15404. Epub 2024 Jul 16.
The use of stereotactic ablative radiotherapy (SABR) over conventional fractionated radiotherapy (CFRT) for early-stage non-small-cell lung cancer (NSCLC) has been advocated, but is also debated in the literature.
In this retrospective cohort study, we adopted a target trial emulation framework to identify eligible patients diagnosed between 2011 and 2021 using the Taiwan Cancer Registry. In the primary analysis, the overall survival (OS) was the primary endpoint, whereas incidences of lung cancer mortality and radiation pulmonary toxicity were the secondary endpoints. Extensive supplementary analyses were also conducted.
We included 351 patients in the primary analysis and found that the OS was not significantly different between the SABR (n = 290) and CFRT (n = 61) groups. The propensity score weighting adjusted hazard ratio of death was 0.75 (95% confidence interval 0.53-1.07, p = 0.118). The secondary endpoints and supplementary analyses showed no significant differences.
The OS of patients with early-stage NSCLC treated with SABR was not significantly different from that of patients treated with CFRT alone. The results of the relevant ongoing clinical trials are eagerly awaited.
立体定向消融放疗（SABR）在早期非小细胞肺癌（NSCLC）中的应用优于常规分割放疗（CFRT），这一观点已得到广泛认可，但在文献中也存在争议。
本回顾性队列研究采用目标试验模拟框架，使用台湾癌症登记处，选取 2011 年至 2021 年间确诊的患者作为研究对象。在主要分析中，总生存期（OS）是主要终点，肺癌死亡率和放射性肺毒性的发生率是次要终点。此外，还进行了广泛的补充分析。
我们在主要分析中纳入了 351 名患者，发现 SABR 组（n=290）与 CFRT 组（n=61）的 OS 无显著差异。经过倾向评分加权调整后的死亡风险比为 0.75（95%置信区间 0.53-1.07，p=0.118）。次要终点和补充分析也未显示出显著差异。
接受 SABR 治疗的早期 NSCLC 患者的 OS 与单独接受 CFRT 治疗的患者无显著差异。目前正在进行的相关临床试验的结果备受关注。
