在医学可手术的I期NSCLC中，SBRT或手术后的生存与复发率
Survival and recurrence rates following SBRT or surgery in medically operable Stage I NSCLC
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影响因子:4.4
分区:医学2区 / 肿瘤学3区 呼吸系统3区
发表日期:2024 Nov
作者:
Michael Snider, Joseph K Salama, Matthew Boyer
DOI:
10.1016/j.lungcan.2024.107962
摘要
手术是早期非小细胞肺癌（NSCLC）治疗的标准，而立体定向放射治疗（SBRT）则保留给无法手术的患者。我们假设来自退伍军人健康体系（VAHS）的医学可手术的I期NSCLC患者在接受SBRT或手术后的总生存（OS）、肺癌特异性生存（LCSS）、无进展生存（PFS）和复发率方面具有等效性。我们识别了在2000-2020年期间诊断为I期NSCLC且符合FEV1或DLCO > 60%的预测值、Charlson合并症指数（CCI）为0或1的VAHS患者，接受SBRT或手术治疗。SBRT患者通过倾向评分匹配，以1:1:1的比例与接受肺叶切除术或亚叶切除术的患者匹配。统计OS、LCSS、PFS及复发部位。每组入组103例患者。在中位随访7.9年后，所有患者的5年OS为51%（95% CI 46-57%）。倾向评分匹配后，SBRT组的OS（风险比HR 2.08, 1.59）、LCSS（HR 2.28, 1.97）和PFS（HR 1.97, 1.45）明显低于肺叶切除或亚叶切除组（p<0.05）。区域复发在SBRT组显著更高（15.5%对比6.8%或4.9%；p<0.05），但局部（28.2%对比21.4%或21.4%；p>0.05）和远处复发（10.7%对比9.7%或13.6%；p>0.05）在两组间无显著差异。对于医学可手术的患者，无论是接受肺叶切除还是亚叶切除，其OS、LCSS和PFS均优于SBRT，部分原因可能是SBRT后区域复发较多。这表明，仅依靠肺功能检测和CCI不足以定义适合SBRT的医学可手术患者群体。这些数据支持采取策略以克服SBRT中出现的区域复发。
Abstract
Surgery is the standard of care for early-stage non-small cell lung cancer (NSCLC), with SBRT reserved for patients who are not surgical candidates. We hypothesized overall survival (OS), lung cancer-specific survival (LCSS), progression free survival (PFS), and recurrence rates following SBRT or surgery in medically operable patients with Stage I NSCLC from the Veterans' Health Care System (VAHS) would be equivalent.Medically operable patients diagnosed with Stage I NSCLC between 2000-2020 from the VAHS, determined by an FEV1 or DLCO > 60 % of predicted and Charlson comorbidity index (CCI) of 0 or 1, treated with SBRT or surgery were identified. SBRT patients were propensity score matched in a 1:1:1 ratio to those undergoing resection (SBRT:lobectomy:sub-lobar resection). OS, LCSS, and PFS and site of recurrence were determined.103 patients were included in each cohort. With a median follow-up of 7.9 years 5-year OS for all patients was 51 % (95 % CI 46-57 %). After propensity score matching, OS (HR 2.08, 1.59), LCSS (HR 2.28, 1.97), and PFS (1.97, 1.45) were significantly worse with SBRT compared to either lobectomy or sub-lobar resection, respectively, (p < 0.05 for each comparison). Regional recurrence was significantly higher following SBRT (15.5 % vs 6.8 % or 4.9 %; p < 0.05), but there was no significant difference in local (28.2 % vs 21.4 % or 21.4 %; p > 0.05) or distant recurrence (10.7 % vs 9.7 % or 13.6 %; p > 0.05) when compared to lobectomy or sub-lobar resection, respectively.In medically operable patients, OS, LCSS, and PFS following either lobectomy or sub-lobar resection were superior to that for SBRT for Stage I NSCLC, likely due in part to higher regional recurrence following SBRT. This suggests that pulmonary function test results and CCI alone are insufficient to define a cohort of medically operable patients suited for SBRT. These data support strategies to overcome regional recurrences seen with SBRT.