Lee Eun Hye, Suh Young Joo, Park Jong Won, Moon Jisu, Park Sangjoon, Lee Chang Geol, Yoon Hong In, Park Byung Jo, Lee Jin Gu, Kim Dae Joon, Yong Seung Hyun, Lee Sang Hoon, Lee Chang Young, Cho Jaeho, Kim Eun Young
Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea.
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Cancers (Basel). 2025 Jun 17;17(12):2015. doi: 10.3390/cancers17122015.
With rising life expectancy and widespread lung cancer screening, early-stage non-small cell lung cancer (NSCLC) incidence has increased. While surgery is the standard treatment for operable stage I NSCLC, many patients are ineligible due to age or comorbidities. Stereotactic body radiotherapy (SBRT) has achieved good primary tumor control rates and overall survival. This study compares the outcomes of SBRT and surgery for stage I NSCLC using propensity score overlap-weighted dataset. This retrospective study analyzed clinical stage I NSCLC patients treated at a tertiary hospital from 2012 to 2021. Baseline differences between SBRT and surgery groups were adjusted using overlap weighting. AI-based CT analysis (CT AI-CAD) assessed tumor characteristics, verified by radiologists. Primary outcomes were 5-year cumulative incidence of recurrence and overall survival, with subgroup analyses based on tumor features. Of 1474 patients, 1258 underwent surgery, and 216 received SBRT. After overlap weighting, baseline characteristics were well balanced. The 5-year cumulative incidence of recurrence and OS showed no statistically significant differences between SBRT and surgery groups (recurrence: 16.2% vs. 16.1%; OS: 80.5% vs. 82.9%). Further AI-based CT subgroup analysis showed no significant differences in recurrence rates across tumor features. A solid tumor diameter associated with a significant increase in recurrence was identified as 16.6 mm for SBRT and 18.6 mm for surgery. After overlap weighting, SBRT and surgery showed no statistically significant differences in treatment outcomes in stage I NSCLC. These findings may help guide the timing and selection of safe and effective treatment approaches.
随着预期寿命的延长和肺癌筛查的广泛开展，早期非小细胞肺癌（NSCLC）的发病率有所上升。虽然手术是可切除的I期NSCLC的标准治疗方法，但许多患者由于年龄或合并症而不符合手术条件。立体定向体部放疗（SBRT）已取得了良好的原发肿瘤控制率和总生存率。本研究使用倾向评分重叠加权数据集比较了SBRT和手术治疗I期NSCLC的疗效。这项回顾性研究分析了2012年至2021年在一家三级医院接受治疗的临床I期NSCLC患者。使用重叠加权法调整SBRT组和手术组之间的基线差异。基于人工智能的CT分析（CT AI-CAD）评估肿瘤特征，并由放射科医生进行验证。主要结局指标为5年累积复发率和总生存率，并根据肿瘤特征进行亚组分析。在1474例患者中，1258例接受了手术，216例接受了SBRT。重叠加权后，基线特征得到了很好的平衡。SBRT组和手术组的5年累积复发率和总生存率在统计学上无显著差异（复发率：16.2%对16.1%；总生存率：80.5%对82.9%）。进一步基于人工智能的CT亚组分析显示，不同肿瘤特征的复发率无显著差异。SBRT组复发率显著增加的实性肿瘤直径为16.6 mm，手术组为18.6 mm。重叠加权后，SBRT和手术治疗I期NSCLC的治疗效果在统计学上无显著差异。这些发现可能有助于指导安全有效治疗方法的时机选择和选择。
