SBRT或手术后的生存和复发率在医学上可操作的I NSCLC中
Survival and recurrence rates following SBRT or surgery in medically operable Stage I NSCLC
影响因子:4.40000
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
摘要
手术是早期非小细胞肺癌（NSCLC）的护理标准，SBRT保留给非手术候选者的患者。我们假设在医学可手术的I NSCLC患者中，从退伍军人的医疗保健系统（VAHS）中，通过诊断为I NSCLS的INSCLS（VAHS），在SBRT或手术后，SBRT或手术后，SBRT或手术后，由INSCLT诊断为I NSCLC的患者（VAHS）将是INSCLS诊断的2000年代220，则假设了SBRT或手术后的SBRT或手术后的总体生存期（OS），肺癌特异性生存率（LCS），无进展生存率（PFS）和复发率或手术后的复发率或手术。鉴定出使用SBRT或手术治疗的DLCO> 60％的预测合并症指数（CCI）为0或1。 SBRT患者的倾向评分与接受切除的患者的比例为1：1：1（SBRT：叶切除术：亚细胞切除术）。确定了OS，LCSS和PFS以及复发部位。103例患者包括每个队列中。所有患者的中位随访为7年5年，为51％（95％CI 46-57％）。在倾向得分匹配之后，与肺切除术或子叶切除术相比，SBRT的OS（HR 2.08、1.59），LCSS（HR 2.28、1.97）和PFS（1.97、1.45）的差异明显较差（每次比较p <0.05）。 SBRT之后（15.5％vs 6.8％或4.9％； P <0.05）明显更高，但局部没有显着差异（28.2％vs 21.4％或21.4％或21.4％； P> 0.05）或远处复发性（10.7％vs 9.7％或13.6％; P> 0.05; p> 0.05; p> 0.05; p> 0.05;在叶切除术或亚叶骨切除后，患者，OS，LCSS和PFS优于SBRT，对于I期NSCLC，患者可能部分归因于SBRT后较高的区域复发。这表明肺功能测试结果，仅CCI不足以定义适合SBRT的医学可手术患者的队列。这些数据支持克服SBRT看到的区域复发的策略。
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.