A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stage I non-small cell lung cancer in patients at high risk for lobectomy: the results in a Chinese population

Xiao-Shuai Yuan; Wu-Cheng Chen; Qing-Ren Lin; Yuan-Jun Liu; Yao-Yao Zhu; Xiao-Jiang Sun; Qiong-Ya Wu; Jin-Shi Liu; Ya-Ping Xu

doi:10.21037/jtd-21-339

A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stage I non-small cell lung cancer in patients at high risk for lobectomy: the results in a Chinese population

J Thorac Dis. 2021 Mar;13(3):1822-1832. doi: 10.21037/jtd-21-339.

Authors

Xiao-Shuai Yuan¹, Wu-Cheng Chen², Qing-Ren Lin³, Yuan-Jun Liu³, Yao-Yao Zhu¹, Xiao-Jiang Sun², Qiong-Ya Wu¹, Jin-Shi Liu⁴, Ya-Ping Xu^{1

2

3}

Affiliations

¹ Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China.
² First Clinical Medical School, Wenzhou Medical University, Wenzhou, China.
³ Department of Radiation Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China.
⁴ Department of Thoracic Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China.

Abstract

Background: To investigate the comparative effectiveness of stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) in patients with stage I non-small cell lung cancer (NSCLC) considered to be high-risk lobectomy patients.

Methods: From January 2012 to December 2015, patients who underwent SBRT or SLR for clinical stage I NSCLC were examined retrospectively. Propensity score matching (PSM) was performed to reduce selection bias in SBRT and SLR patients.

Results: Data from 86 SBRT and 79 SLR patients was collected. Median follow-up periods of the SBRT and SLR groups were 32 and 37 months, respectively. Patients treated with SBRT exhibited significantly higher age, higher likelihood of being male, larger tumor diameter, lower forced expiratory volume in 1 second (FEV1), and poorer performance status compared with SLR patients. There were no significant differences between SBRT and SLR patients for 3-year overall survival (OS) (80.3% and 82.3%, P=0.405), cause-specific survival (CSS) (81.3% and 83.4%, P=0.383), and local control (LC) (89.7% and 86.0%, P=0.501). Forty-nine patients were identified from each group after performing PSM. After patients were matched for age, gender, performance status, tumor characteristics and pulmonary function, no significant differences were observed in 3-year OS (85.4% and 73.3%, P=0.649), CSS (87.2% and 74.9%, P=0.637) and LC (95.6% and 82.1%, P=0.055). Prevalence of significant adverse events (grade 3 or worse) was 0% and 10.2% in the matched SBRT and SLR groups (P=0.056), respectively.

Conclusions: Disease control and survival in the SBRT patients was equivalent to that seen in SLR patients with stage I NSCLC considered high-risk lobectomy candidates. SBRT could therefore be an alternative option to SLR in treating patients with a high operative risk.

Keywords: Non-small cell lung cancer (NSCLC); propensity score; stereotactic body radiotherapy (SBRT); sublobar resection (SLR).