Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Radiotherapy for Stage I Lung Cancer
Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Radiotherapy for Stage I Lung Cancer
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DOI：
10.1016/j.athoracsur.2014.11.009
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发表时间：
2015-03-27
影响因子：
4.6
通讯作者：
Date, Hiroshi
中科院分区：
文献类型：
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作者：
Hamaji, Masatsugu;Chen, Fengshi;Date, Hiroshi
背景以往立体定向体部放射治疗（stereotactic body radiotherapy，SBRT）与手术治疗非小细胞肺癌（non-small cell lung cancer，NSCLC）的比较报道存在随访时间短、切除范围不一、良性病变夹杂等问题。我们的目的是比较一系列单纯的电视胸腔镜手术（VATS）肺叶切除术和SBRT对经活检证实的临床I期NSCLC的长期疗效。我们回顾性比较了2003年至2009年期间在我们机构进行的VATS肺叶切除术（n = 413）和SBRT（n = 104）治疗经活检证实的临床I期NSCLC的总生存期（OS）、病因特异性生存期（CSS）、无复发生存期（RFS）、局部控制、区域淋巴结（LN）控制和远处控制。倾向评分匹配用于调整估计治疗风险比的混杂效应。对41例VATS肺叶切除术患者和41例SBRT患者的结果进行盲法匹配（1：1比例，卡尺距离; 0.5）。倾向评分匹配后，整个队列的随访时间范围为5 - 120个月，中位数为48个月。倾向评分匹配后，OS（p = 0.0016）、CSS（p = 0.0015）、RFS（p < 0.0001）、局部控制（p = 0.0019）和远处控制（p < 0.0001）存在显著差异，而局部LN控制无显著差异（p = 0.11）。VATS肺叶切除术和SBRT患者的5年OS分别为68.5%和37.3%，5年CSS分别为83.5%和56.7%，5年RFS分别为60.4%和19.5%。我们的研究结果表明，对于经活检证实的临床I期非小细胞肺癌患者，VATS肺叶切除术可能比SBRT提供更有利的长期结局。(C)2015年美国胸外科医师协会
Background. Previous comparative reports of stereotactic body radiotherapy (SBRT) and surgery for non-small cell lung cancer (NSCLC) suffered from short follow-up, mixed extents of resection and inclusion of benign lesion. We aimed to make comparisons of long-term outcomes between a pure series of video-assisted thoracoscopic surgery (VATS) lobectomy and SBRT for biopsy-proven clinical stage I NSCLC.Methods. We retrospectively compared overall survival (OS), cause-specific survival (CSS), recurrence-free survival (RFS), local control, regional lymph node (LN) control, and distant control between VATS lobectomy (n = 413) and SBRT (n = 104) for biopsy-proven clinical stage I NSCLC at our institution between 2003 and 2009. Propensity score matching was used to adjust the confounding effects in estimating treatment hazard ratios. Forty-one VATS lobectomy patients and 41 SBRT patients were matched blinded to outcome (1:1 ratio, caliper distance; 0.5).Results. After propensity score matching, the follow-up period of the whole cohort ranged from 5 to 120 months with a median of 48. After propensity score matching there were significant differences in OS (p = 0.0016), CSS (p = 0.0015), RFS (p < 0.0001), local control (p = 0.0019), and distant control (p < 0.0001) and no significant difference in regional LN control (p = 0.11). The VATS lobectomy patients and SBRT patients had 68.5% and 37.3% of 5-year OS, 83.5% and 56.7% of 5-year CSS, and 60.4% and 19.5% of 5-year RFS, respectively.Conclusions. Our results suggest VATS lobectomy may offer significantly more favorable long-term outcomes than SBRT in potentially operable patients with biopsyproven clinical stage I NSCLC. (C) 2015 by The Society of Thoracic Surgeons