Early-stage NSCLC: surgery bests stereotactic body radiotherapy

  • Chi A & al.
  • JAMA Netw Open
  • 1 Nov 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Patients with early-stage NSCLC who undergo surgery have better OS than those treated with stereotactic body radiotherapy (SBRT), especially when regional lymph node examination (LNE) included >10 lymph nodes.

Why this matters

  • Prior studies comparing survival between surgery and SBRT have yielded conflicting results.

Study design

  • 104,709 patients with early-stage NSCLC from the National Cancer Database underwent SBRT (n=13,379) or surgery (n=91,330).
  • Funding: None disclosed.

Key results

  • All surgery types were associated with better OS compared with SBRT:
    • Wedge resection: aHR, 0.67; P<.001.>
    • Segmentectomy: aHR, 0.60; P<.001.>
    • Lobectomy: aHR, 0.53; P<.001.>
    • Pneumonectomy: aHR, 0.75; P<.001.>
  • Surgical patients with regional LNE had significantly better OS than those with no LNE (63.6% vs 49.8%; HR, 0.66; P<.001 and lne of>10 lymph nodes was associated with the best OS (50.2% with 0 LNE vs 62.9% with 1-10 LNEs vs 65.3% with 11-15 LNEs vs 64.6% with >15 LNEs; P<.001>
  • In SBRT patients, there was no significant difference in OS between patients who received regional LNE and those that underwent SBRT alone.
  • After propensity matching, sublobar resection (HR, 0.56; P<.001 and lobar resection p were associated with decreased mortality risk compared sbrt.>

Limitations

  • Possible selection bias.