手术是早期非小细胞肺癌 (NSCLC) 的标准治疗方法，SBRT 只适用于不适合手术的患者。我们假设来自退伍军人医疗保健系统 (VAHS) 的可进行医学手术的 I 期 NSCLC 患者的总生存期 (OS)、肺癌特异性生存期 (LCSS)、无进展生存期 (PFS) 以及 SBRT 或手术后的复发率确定了 2000 年至 2020 年间通过 VAHS 诊断为 I 期 NSCLC 的可进行医学手术的患者，其由 FEV1 或 DLCO 确定 > 预测值的 60%，查尔森合并症指数 (CCI) 为 0 或 1，并接受 SBRT 或手术治疗。 SBRT 患者的倾向评分与接受切除术的患者（SBRT：肺叶切除术：亚肺叶切除术）按 1:1:1 的比例进行匹配。确定 OS、LCSS 和 PFS 以及复发部位。每个队列包含 103 名患者。中位随访时间为 7.9 年，所有患者的 5 年 OS 率为 51% (95% CI 46-57%)。倾向评分匹配后，与肺叶切除术或亚肺叶切除术相比，SBRT 的 OS (HR 2.08, 1.59)、LCSS (HR 2.28, 1.97) 和 PFS (1.97, 1.45) 显着较差（p < 0.05）每次比较）。 SBRT 后区域复发率显着较高（15.5% vs 6.8% 或 4.9%；p < 0.05），但局部复发率（28.2% vs 21.4% 或 21.4%；p>0.05）或远处复发率（10.7%）没有显着差异。分别与肺叶切除术或亚肺叶切除术相比，分别为 9.7% 或 13.6%；p>0.05。在可进行医学手术的患者中，肺叶切除术或亚肺叶切除术后的 OS、LCSS 和 PFS 优于 SBRT I 非小细胞肺癌，部分原因可能是 SBRT 后区域复发率较高。这表明，仅肺功能测试结果和 CCI 不足以定义适合 SBRT 的可进行医学手术的患者队列。这些数据支持克服 SBRT 局部复发的策略。版权所有 © 2024 Elsevier B.V. 保留所有权利。

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.Copyright © 2024 Elsevier B.V. All rights reserved.