Surgery versus stereotactic body radiotherapy for clinical stage I non-small-cell lung cancer: propensity score-matching analysis including the ratio of ground glass nodules
Surgery versus stereotactic body radiotherapy for clinical stage I non-small-cell lung cancer: propensity score-matching analysis including the ratio of ground glass nodules
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DOI：
10.1007/s12094-020-02459-8
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发表时间：
2020-07-23
影响因子：
3.4
通讯作者：
Shibamoto, Y.
中科院分区：
文献类型：
--
作者：
Tomita, N.;Okuda, K.;Shibamoto, Y.
目的探讨手术和立体定向体部放射治疗（SBRT）对临床分期（c-stage）I期非小细胞肺癌（NSCLC）的疗效是否具有可比性，进行倾向评分匹配（PSM）分析。这项单机构回顾性研究包括2004年至2014年期间接受手术（n = 574）或SBRT（n = 182）的患者。根据肿瘤直径、年龄、性别、体力状态、用力呼气量、Charlson合并症指数和根据第8次TNM分类定义为cTis或cT 1 mi的磨玻璃结节（GGN）进行PSM。结果手术组和SBRT组的中位随访时间分别为66个月和69个月。多因素分析显示，非GGN是总生存期（OS）和无病生存期（DFS）较差的显著因素：风险比（HR）19.95%置信区间（CI）4.7-79，P < 0.001; HR 28，95% CI 6.9-110，P < 0.001。PSM从每组中确定了120名患者。PSM后，手术组与SBRT组的5年OS和DFS率分别为71%（95% CI 61-79）vs 64%（95% CI 54-72）（P = 0.41）和63%（95% CI 53-72）vs 55%（95% CI 45-63）（P = 0.23）。结论PSM分析显示，手术组的生存率和无瘤生存率均略上级SBRT组，但两组生存率差异无统计学意义。
Purpose To investigate whether surgery and stereotactic body radiotherapy (SBRT) yield comparable outcomes for clinical stage (c-stage) I non-small-cell lung cancer (NSCLC), propensity score-matching (PSM) analysis was conducted. Methods This single-institutional retrospective study included patients who underwent surgery (n = 574) or SBRT (n = 182) between 2004 and 2014. PSM was performed based on tumor diameter, age, sex, performance status, forced expiratory volume, Charlson comorbidity index, and ground glass nodules (GGN) defined as cTis or cT1mi according to the 8th TNM classification. Results The median follow-up durations for the surgery and SBRT groups were 66 and 69 months, respectively. The multivariate analysis revealed that non-GGN was a significant factor for poorer overall survival (OS) and disease-free survival (DFS): hazard ratio (HR) 19.95% confidence interval (CI) 4.7-79,P < 0.001; and HR 28, 95% CI 6.9-110,P < 0.001, respectively. PSM identified 120 patients from each group. The 5-year OS and DFS rates of the surgery vs SBRT groups were 71% (95% CI 61-79) vs 64% (95% CI 54-72) (P = 0.41) and 63% (95% CI 53-72) vs 55% (95% CI 45-63) (P = 0.23) after PSM, respectively. Conclusion The PSM analyses including the ratio of GGN demonstrated that the OS and DFS for patients with c-stage I NSCLC in the surgery group were slightly superior to those for those in the SBRT group, although both survivals were not significantly different between the two therapeutic approaches.