Cancer Res Treat.  2023 Oct;55(4):1171-1180. 10.4143/crt.2022.1581.

Sublobar Resection versus Stereotactic Body Radiation Therapy for Clinical Stage I Non–Small Cell Lung Cancer: A Study Using Data from the Korean Nationwide Lung Cancer Registry

• Yun J
• Cho JH
• Hong TH
• Yang K
• Ahn YC
• Kim HK
• Korean Association for Lung Cancer
• Korea Central Cancer Registry

• KMID: 2547791
• DOI: http://doi.org/10.4143/crt.2022.1581

Abstract

Purpose
Stereotactic body radiotherapy (SBRT) had been increasingly recognized as a favorable alternative to surgical resection in patients with high risk for surgery. This study compared survival outcomes between sublobar resection (SLR) and SBRT for clinical stage I non–small cell lung cancer (NSCLC).
Materials and Methods
Data were obtained from the Korean Association of Lung Cancer Registry, a sampled nationwide database. This study retrospectively reviewed 382 patients with clinical stage I NSCLC who underwent curative SLR or SBRT from 2014 to 2016.
Results
Of the patients, 43 and 339 underwent SBRT and SLR, respectively. Patients in the SBRT group were older and had worse pulmonary function. The 3-year overall survival (OS) rate was significantly better in the SLR group compared with the SBRT group (86.6% vs. 57%, log-rank p < 0.001). However, after adjusting for age, sex, tumor size, pulmonary function, histology, smoking history, and adjuvant therapy, treatment modality was not an independent prognostic factor for survival (hazard ratio, 0.99; 95% confidence interval, 0.43 to 2.77; p=0.974). We performed subgroup analysis in the following high-risk populations: patients who were older than 75 years; patients who were older than 70 years and had diffusing capacity of lung for carbon monoxide ≤ 80%. In each subgroup, there were no differences in OS and recurrence-free survival between patients who underwent SLR and those who received SBRT.
Conclusion
In our study, there were no significant differences in terms of survival or recurrence between SBRT and SLR in medically compromised stage I NSCLC patients. Our findings suggest that SBRT could be considered as a potential treatment option for selected patients.

Keyword

Radiosurgery; Sublobar resection; Non-small cell lung carcinoma

Figure

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  Fig. 1 Survival outcomes. The sublobar resection (SLR) group has better overall survival (A) and recurrence-free survival (B) compared with those in the stereotactic body radiation therapy (SBRT) group. However, CIR (C) was similar between the two groups. CI, confidence interval.

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  Fig. 2 Forest plot. Multivariable Cox proportional hazard analysis was performed to determine the independent prognostic factors of overall survival. Older age, male sex, low diffusing capacity of lung for carbon monoxide (DLCO), histology other than adenocarcinoma (ADC) or squamous cell carcinoma (SCC), and adjuvant treatment were the independent poor prognostic factors. Treatment strategy (stereotactic body radiation therapy [SBRT] or surgery) was not an independent prognostic factor for survival. AIC, akaike information criterion; FEV1, forced expiratory volume in 1 second; SLR, sublobar resection. *p < 0.05, **p < 0.01.

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  Fig. 3 Subgroup analysis. There was no significant difference in overall survival and recurrence-free survival between the sublobar resection (SLR) and stereotactic body radiation therapy (SBRT) groups in both subgroup of patients ≥ 75 years (A) and the subgroup of patients ≥ 70 years of age and with a diffusing capacity of lung for carbon monoxide (DLCO) ≤ 80% (B).

Reference

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