TY - JOUR
T1 - The optimal treatment for patients with stage I non-small cell lung cancer: minimally invasive lobectomy versus stereotactic ablative radiotherapy – a nationwide cohort study
AU - Ruiter, Julianne Cynthia de
AU - Noort, Vincent van der
AU - Diessen, Judi Nani Annet van
AU - Smit, Egbert Frederik
AU - Damhuis, Ronald
AU - Hartemink, Koen
AU - ESLUNG Group
AU - Halfwerk, F.R.
PY - 2024/5
Y1 - 2024/5
N2 - ObjectivesThe
aim of the Early-Stage LUNG cancer (ESLUNG) study was to compare
outcomes after minimally invasive lobectomy (MIL) and stereotactic
ablative radiotherapy (SABR) in patients with stage I non-small cell
lung cancer (NSCLC).Materials and methodsIn
this retrospective cohort study, patients with clinical stage I NSCLC
(according to TNM7), treated in 2014–2016 with MIL or SABR, were
included. 5-year overall survival (OS) and recurrence-free survival
(RFS) were calculated and compared between patients treated with MIL and
a propensity score (PS)-weighted SABR population with characteristics
comparable to those of the MIL group.Results1211
MIL and 972 SABR patients were included. Nodal upstaging occurred in
13.0 % of operated patients. 30-day mortality was 1.0 % after MIL and
0.2 % after SABR. After SABR, the 5-year regional recurrence rate (18.1
versus 14.2 %; HR 0.74, 95 % CI 0.58–0.94) and distant metastasis rate
(26.2 versus 20.2 %; HR 0.72, 95 % CI 0.59–0.88) were significantly
higher than after MIL, with similar local recurrence rate (13.1 versus
12.1 %; HR 0.90, 95 % CI 0.68–1.19). Unadjusted 5-year OS and RFS were
70.2 versus 40.3 % and 58.0 versus 25.1 % after MIL and SABR,
respectively. PS-weighted, multivariable analyses showed no significant
difference in OS (HR 0.89, 95 % CI 0.65–1.20) and better RFS after MIL
(HR 0.70, 95 % CI 0.49–0.99).ConclusionOS
was not significantly different between stage I NSCLC patients treated
with MIL and the PS-weighted population of patients treated with SABR.
For operable patients with stage I NSCLC, SABR could therefore be an
alternative treatment option with comparable OS outcome. However, RFS
was better after MIL due to fewer regional recurrences and distant
metastases. Future studies should focus on optimization of patient
selection for MIL or SABR to further reduce postoperative mortality and
morbidity after MIL and nodal failures after SABR.
AB - ObjectivesThe
aim of the Early-Stage LUNG cancer (ESLUNG) study was to compare
outcomes after minimally invasive lobectomy (MIL) and stereotactic
ablative radiotherapy (SABR) in patients with stage I non-small cell
lung cancer (NSCLC).Materials and methodsIn
this retrospective cohort study, patients with clinical stage I NSCLC
(according to TNM7), treated in 2014–2016 with MIL or SABR, were
included. 5-year overall survival (OS) and recurrence-free survival
(RFS) were calculated and compared between patients treated with MIL and
a propensity score (PS)-weighted SABR population with characteristics
comparable to those of the MIL group.Results1211
MIL and 972 SABR patients were included. Nodal upstaging occurred in
13.0 % of operated patients. 30-day mortality was 1.0 % after MIL and
0.2 % after SABR. After SABR, the 5-year regional recurrence rate (18.1
versus 14.2 %; HR 0.74, 95 % CI 0.58–0.94) and distant metastasis rate
(26.2 versus 20.2 %; HR 0.72, 95 % CI 0.59–0.88) were significantly
higher than after MIL, with similar local recurrence rate (13.1 versus
12.1 %; HR 0.90, 95 % CI 0.68–1.19). Unadjusted 5-year OS and RFS were
70.2 versus 40.3 % and 58.0 versus 25.1 % after MIL and SABR,
respectively. PS-weighted, multivariable analyses showed no significant
difference in OS (HR 0.89, 95 % CI 0.65–1.20) and better RFS after MIL
(HR 0.70, 95 % CI 0.49–0.99).ConclusionOS
was not significantly different between stage I NSCLC patients treated
with MIL and the PS-weighted population of patients treated with SABR.
For operable patients with stage I NSCLC, SABR could therefore be an
alternative treatment option with comparable OS outcome. However, RFS
was better after MIL due to fewer regional recurrences and distant
metastases. Future studies should focus on optimization of patient
selection for MIL or SABR to further reduce postoperative mortality and
morbidity after MIL and nodal failures after SABR.
KW - n/a OA procedure
U2 - 10.1016/j.lungcan.2024.107792
DO - 10.1016/j.lungcan.2024.107792
M3 - Article
SN - 0169-5002
VL - 191
JO - Lung cancer
JF - Lung cancer
M1 - 107792
ER -
