Stereotactic Body Radiation Therapy Versus Surgery for Early Lung Cancer Among US Veterans
Stereotactic Body Radiation Therapy Versus Surgery for Early Lung Cancer Among US Veterans
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DOI：
10.1016/j.athoracsur.2017.07.048
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发表时间：
2018-02-01
影响因子：
4.6
通讯作者：
Murphy, James D.
中科院分区：
文献类型：
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作者：
Bryant, Alex K.;Mundt, Robert C.;Murphy, James D.
背景立体定向体部放射治疗（SBRT）已被提出作为早期肺癌手术的潜在替代方案，尽管我们缺乏比较这些治疗的前瞻性随机数据，并且现有研究存在混杂因素的不完整信息，可能导致结果偏倚。在这里，我们评估了手术和SBRT在肺癌治疗中的比较有效性，使用了退伍军人事务系统的大量详细数据库。我们从退伍军人事务信息学和计算基础设施中确定了2006年至2015年间诊断出的经活检证实的临床I期非小细胞肺癌退伍军人。我们使用单变量和多变量竞争风险分析比较了接受肺叶切除术、肺叶下切除术或SBRT的患者的癌症特异性生存率。多变量分析调整了混杂因素，包括术前肺功能、吸烟状况、合并症和分期检查程序。共纳入4，069例患者（449例SBRT，2，986例肺叶切除术，634例肺叶下切除术）。未经调整的分析发现，与SBRT组相比，手术组的术后即刻死亡率较高。考虑长期生存的多变量分析发现SBRT的癌症特异性死亡率高于肺叶切除术（子分布风险比1.45，95%置信区间：1.09至1.94，p = 0.01），尽管SBRT和肺叶下切除术之间没有生存差异（子分布风险比1.25，95%置信区间：0.93 ~ 1.68，p = 0.15）。在一个大的早期肺癌患者队列中，我们发现肺叶切除术与SBRT相比提高了生存率，尽管我们发现肺叶下切除术与SBRT之间没有生存差异。尽管有这些发现，但仍存在不可测量的混淆的可能性，需要进行前瞻性随机试验来更好地比较这些治疗方式。(C)2018胸外科医师协会
Background. Stereotactic body radiation therapy (SBRT) has been proposed as a potential alternative to surgery for early lung cancer, although we lack well-powered prospective randomized data comparing these treatments, and existing studies suffer from incomplete information on confounders that can bias results. Here, we evaluated the comparative effectiveness of surgery and SBRT in lung cancer treatment using a large extensively detailed database from the Veteran's Affairs system.Methods. We identified veterans with biopsy-proven clinical stage I non-small cell lung cancer diagnosed between 2006 and 2015 from within the Veteran's Affairs Informatics and Computing Infrastructure. We compared cancer-specific survival among patients receiving lobectomy, sublobar resection, or SBRT using univariable and multivariable competing risk analyses. Multivariable analyses adjusted for confounders including preoperative pulmonary function, smoking status, comorbidity, and staging workup procedures.Results. In all, 4,069 patients were included (449 SBRT, 2,986 lobectomy, 634 sublobar resection). Unadjusted analysis found higher immediate postprocedural mortality in the surgery groups compared with the SBRT group. The multivariable analysis considering long-term survival found higher cancerspecific mortality for SBRT compared with lobectomy (subdistribution hazard ratio 1.45, 95% confidence interval: 1.09 to 1.94, p = 0.01), although no survival difference between SBRT and sublobar resection (subdistribution hazard ratio 1.25, 95% confidence interval: 0.93 to 1.68, p = 0.15).Conclusions. Among a large cohort of early stage lung cancer patients, we found that lobectomy had improved survival compared with SBRT, although we found no survival difference between sublobar resection and SBRT. Despite these findings, the potential for unmeasured confounding remains and prospective randomized trials are needed to better compare these treatment modalities. (C) 2018 by The Society of Thoracic Surgeons