Prospective Cohort Study to Compare Long-Term Lung Cancer-Specific and All-Cause Survival of Clinical Early Stage (T1a–b; ≤20 mm) NSCLC Treated by Stereotactic Body Radiation Therapy and Surgery

医学肺癌倾向得分匹配比例危险模型内科学置信区间肿瘤科前瞻性队列研究生存分析队列外科

作者

Claudia I. Henschke,Rowena Yip,Qi Sun,Pengfei Li,Andrew Kaufman,Robert M. Samstein,Cliff P. Connery,Leslie J. Kohman,Paul Lee,Henry Tannous,David F. Yankelevitz,Emanuela Taioli,Kenneth E. Rosenzweig,Raja M. Flores,Raja M. Flores,Andrew Kaufman,Dong‐Seok Lee,Daniel Nicastri,Andrea Wolf,Kimberly J. Song,Kenneth E. Rosenzweig,Jorge Gómez,Robert M. Samstein,Pinaki Dutta,Mary Beth Beasley,Maureen F. Zakowski,Michael Chung,David F. Yankelevitz,Claudia I. Henschke,Emanuela Taioli,Rebecca M. Schwartz,Huiwen Chan,Jeffrey Zhu,Sydney Kantor,Sydney Woode,Daniel Nicastri,Ardeshir Hakami,Arzu Büyük,Adie Friedman,Ronald Dreifuss,Stacey Verzosa,Mariya Yakubox,Karina Aloferdova,Patricia Stacey,Simone De Nobrega,Jeffrey Zhu,Sydney Kantor,Sydney Woode,Ardeshir Hakami,Jeffrey Zhu,Sydney Kantor,Sydney Woode,Lauren Lentini,Harvey I. Pass,Benjamin T. Cooper,Andre Moreirea,Audrey Sorensen,Leslie J. Kohman,Robert F. Dunton,Jason Wallen,Christopher Curtiss,Ernest M. Scalzetti,L. E. Ellinwood,Henry Tannous,Cliff P. Connery,Emilo Torres,Dan Cruzer,Bruce Gendron,Sonya Alyea,Pramila Krumholtz,Ammara A. Watkins,Elliot L. Servais,Cameron Stock,Andrea B. McKee,Edilin Lopez,Howard Hsu,Kaudia Hunter,Jeffrey M. Lemons,Asa J. Nixon,Etin-Osa Osa,Paul Lee,Kevin Hyman,Julisa Jurado,David Zeltman,Lawrence Glassman,Rajiv Sharma,Vijay Singh,Efstathia Milhelis,Nandanee Karan,Witold Rzyman,Robert Dziedzic,Raja M. Flores,Claudia I. Henschke,Emanuela Taioli,David F. Yankelevitz,Rebecca M. Schwartz,Artit Jirapatnakul,Rowena Yip,Huiwen Chan,Claudia I. Henschke,David F. Yankelevitz,Rowena Yip,Artit Jirapatnakul,Raja M. Flores,Andrew Kaufman,Andrea Wolf,Daniel Nicastri,Javier J. Zulueta,Emanuela Taioli,Anthony P. Reeves,Nasser K. Altorki,James P. Smith,Daniel M. Libby,Mark Pasmantier,Steven Markowitz,Albert Miller,José Cervera Deval,Dorith Shaham,Luis Seijó,Gorka Bastarika,Luis M. Montuenga,Silver Spring,Cheryl Aylesworth,Karl Klingler,Othmar Schöb,Shahriyour Andaz,Michaela Straznicka,Cynthia Chin,Todd S. Weiser,Shusuke Sone,Takaomi Hanaoka,Heidi Roberts,Demetris Patsios,M. Scopetuolo,Andrew B. Brown,Ning Wu,Enser Cole,Diana Yeh,Dan W. Luedke,Xueguo Liu,Gary Herzog,Ralph W. Aye,Matthew D. Rifkin,Giula Veronesi,Maurizio Infante,Davood Vafai,Samuel Kopel,Jana Taylor,Richard J. Thurer,Nestor Villamizar,John H. M. Austin,Gregory D. Pearson,Donald Klippenstein,Alan Litwin,Peter Loud,Leslie J. Kohman,Ernest M. Scalzetti,Arfa Khan,Rakesh Shah,William Mayfield,Carmine Frumiento,Michael V. Smith,M. Kristin Thorsen,Richard M. Hansen,David P. Naidich,Georgeann McGuinness,Mark Widmann,Robert J. Korst,J. Lowry,Mary Salvatore,James J. Walsh,David Bertsch,Paul Scheinberg,Barry Sheppard,G Cecchi,Michelle S. Ginsberg,Laura S. Welch,Dan J. Raz,A Rotter,Cliff P. Connery,Terence A.S. Matalon,Edson H. Cheung,Robert Glassberg,David R. Olsen,David Mullen,Shari-Lynn Odzer,Peter H. Wiernik,Daniel Ray,Louis DeCunzo,Harvey I. Pass,Carmen Endress,Anthony Vacca,Meera Kondapaneni,Melissa Lim,Michael Kalafer,Jeremy Green,Mark Yoder,Palmi Shah,Elmer Camacho,James O’Brien,James C. Willey,David Gordon,Albert Kocha

出处

期刊：Journal of Thoracic Oncology [Elsevier]
日期：2023-10-07 卷期号：19 (3): 476-490 被引量：5

链接

nih.govdoi.org

标识

DOI：10.1016/j.jtho.2023.10.002

摘要

Abstract

Introduction

We aimed to compare outcomes of patients with first primary clinical T1a-bN0M0 NSCLC treated with surgery or stereotactic body radiation therapy (SBRT).

Methods

We identified patients with first primary clinical T1a-bN0M0 NSCLCs on last pretreatment computed tomography treated by surgery or SBRT in the following two prospective cohorts: International Early Lung Cancer Action Program (I-ELCAP) and Initiative for Early Lung Cancer Research on Treatment (IELCART). Lung cancer-specific survival and all-cause survival after diagnosis were compared using Kaplan-Meier analysis. Propensity score matching was used to balance baseline demographics and comorbidities and analyzed using Cox proportional hazards regression.

Results

Of 1115 patients with NSCLC, 1003 had surgery and 112 had SBRT; 525 in I-ELCAP in 1992 to 2021 and 590 in IELCART in 2016 to 2021. Median follow-up was 57.6 months. Ten-year lung cancer-specific survival was not significantly different: 90% (95% confidence interval: 87%–92%) for surgery versus 88% (95% confidence interval: 77%–99%) for SBRT, p = 0.55. Cox regression revealed no significant difference in lung cancer-specific survival for the combined cohorts (p = 0.48) or separately for I-ELCAP (p = 1.00) and IELCART (p = 1.00). Although 10-year all-cause survival was significantly different (75% versus 45%, p < 0.0001), after propensity score matching, all-cause survival using Cox regression was no longer different for the combined cohorts (p = 0.74) or separately for I-ELCAP (p = 1.00) and IELCART (p = 0.62).

Conclusions

This first prospectively collected cohort analysis of long-term survival of small, early NSCLCs revealed that lung cancer-specific survival was high for both treatments and not significantly different (p = 0.48) and that all-cause survival after propensity matching was not significantly different (p = 0.74). This supports SBRT as an alternative treatment option for small, early NSCLCs which is especially important with their increasing frequency owing to low-dose computed tomography screening. Furthermore, treatment decisions are influenced by many different factors and should be personalized on the basis of the unique circumstances of each patient.

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