Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States.
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States; Radiation Oncology Clinical Service, Durham VA Health Care System, Durham, NC, United States.
Lung Cancer. 2024 Nov;197:107962. doi: 10.1016/j.lungcan.2024.107962. Epub 2024 Sep 23.
Surgery is the standard of care for early-stage non-small cell lung cancer (NSCLC), with SBRT reserved for patients who are not surgical candidates. We hypothesized overall survival (OS), lung cancer-specific survival (LCSS), progression free survival (PFS), and recurrence rates following SBRT or surgery in medically operable patients with Stage I NSCLC from the Veterans' Health Care System (VAHS) would be equivalent.
Medically operable patients diagnosed with Stage I NSCLC between 2000-2020 from the VAHS, determined by an FEV1 or DLCO > 60 % of predicted and Charlson comorbidity index (CCI) of 0 or 1, treated with SBRT or surgery were identified. SBRT patients were propensity score matched in a 1:1:1 ratio to those undergoing resection (SBRT:lobectomy:sub-lobar resection). OS, LCSS, and PFS and site of recurrence were determined.
103 patients were included in each cohort. With a median follow-up of 7.9 years 5-year OS for all patients was 51 % (95 % CI 46-57 %). After propensity score matching, OS (HR 2.08, 1.59), LCSS (HR 2.28, 1.97), and PFS (1.97, 1.45) were significantly worse with SBRT compared to either lobectomy or sub-lobar resection, respectively, (p < 0.05 for each comparison). Regional recurrence was significantly higher following SBRT (15.5 % vs 6.8 % or 4.9 %; p < 0.05), but there was no significant difference in local (28.2 % vs 21.4 % or 21.4 %; p > 0.05) or distant recurrence (10.7 % vs 9.7 % or 13.6 %; p > 0.05) when compared to lobectomy or sub-lobar resection, respectively.
In medically operable patients, OS, LCSS, and PFS following either lobectomy or sub-lobar resection were superior to that for SBRT for Stage I NSCLC, likely due in part to higher regional recurrence following SBRT. This suggests that pulmonary function test results and CCI alone are insufficient to define a cohort of medically operable patients suited for SBRT. These data support strategies to overcome regional recurrences seen with SBRT.
手术是非小细胞肺癌（NSCLC）早期治疗的标准方法，立体定向放疗（SBRT）适用于不符合手术条件的患者。我们假设，退伍军人医疗保健系统（VAHS）中 I 期 NSCLC 患者在医学上适合手术时，SBRT 与手术的总生存期（OS）、肺癌特异性生存期（LCSS）、无进展生存期（PFS）和复发率相当。
通过测量 FEV1 或 DLCO 大于预测值的 60%和 Charlson 合并症指数（CCI）为 0 或 1，确定 2000 年至 2020 年 VAHS 中 I 期 NSCLC 患者接受 SBRT 或手术治疗的医学手术候选者。采用 1：1：1 的比例将 SBRT 患者与接受肺叶切除术（SBRT：肺叶切除术：亚肺叶切除术）的患者进行倾向评分匹配。确定 OS、LCSS 和 PFS 以及复发部位。
每组纳入 103 例患者。中位随访 7.9 年，所有患者的 5 年 OS 为 51%（95%CI 46-57%）。在倾向评分匹配后，与肺叶切除术或亚肺叶切除术相比，SBRT 的 OS（HR 2.08，1.59）、LCSS（HR 2.28，1.97）和 PFS（1.97，1.45）显著更差（p<0.05 每项比较）。SBRT 后区域复发率明显较高（15.5%比 6.8%或 4.9%；p<0.05），但与肺叶切除术或亚肺叶切除术相比，局部复发率（28.2%比 21.4%或 21.4%；p>0.05）或远处复发率（10.7%比 9.7%或 13.6%；p>0.05）差异无统计学意义。
在医学上适合手术的患者中，肺叶切除术或亚肺叶切除术的 OS、LCSS 和 PFS 优于 SBRT 治疗 I 期 NSCLC，这可能部分归因于 SBRT 后区域复发率较高。这表明，仅通过肺功能测试结果和 CCI 不足以确定适合 SBRT 的医学手术候选者队列。这些数据支持克服 SBRT 所见区域性复发的策略。
