Surgery confers higher 5-year survival rates than radiotherapy in early-stage lung cancer
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Key takeaways:
- Long-term survival favored surgical resection for early-stage NSCLC.
- SBRT represents a potential loss in life-years among this patient population.
Patients with early-stage non-small cell lung cancer who underwent surgical resection had higher rates of long-term survival than those who received stereotactic body radiation therapy, according to study results.
The findings, presented at American Association for Thoracic Surgery Annual Meeting, showed the greatest long-term survival advantage with surgery vs. SBRT among those with a health-associated life expectancy that exceeded 2 years.
Rationale and methods
Patients with early-stage lung cancer are increasingly undergoing SBRT rather than surgical resection, according to researchers.
Brooks Udelsman, MD, fellow in cardiothoracic surgery at Yale School of Medicine, and colleagues sought to evaluate trends in SBRT use and long-term survival outcomes among 30,658 patients with early-stage NSCLC.
They pooled data from the National Cancer Database and compared outcomes of patients who underwent SBRT (n = 5,929; 19.3%) vs. those who underwent surgical resection (n = 24,729; 80.7%) between 2012 and 2018.
Researchers additionally compared perioperative mortality and 5-year survival among propensity-matched patients who received SBRT vs. surgery and for a subset of patients who underwent SBRT with documented refusal of recommended surgery.
Findings
Researchers observed an increase in the proportion of patients who underwent SBRT, from 15.9% in 2012 to 26% in 2018 (P < .001).
Results of logistic regression analysis showed an association between SBRT receipt and increasing age (OR = 1.09; 95% CI, 1.09-1.1) and squamous histology (OR = 1.25; 95% CI, 1.17-1.34).
Researchers additionally found that compared with patients who underwent SBRT, those who underwent surgical resection experienced higher 30-day (0.3% vs. 1.7%; P < .001) and 90-day (1.7% vs. 2.8%; P < .001) mortality rates. However, unadjusted 5-year survival rates appeared higher among patients who underwent resection (75.8% vs. 40.5%; P < .001).
Results of Kaplan Meier of propensity-matched patients showed long-term survival favored SBRT during the first several months, then separated after 1 year and significantly favored the surgical resection group by year 2 (5-year survival, 61.9% for surgery vs. 30.3% for SBRT; P < .001).
Further, among the subset of patients who underwent SBRT and refused recommended surgery, results also demonstrated superior survival with surgical resection (5-year survival, 63.5% for surgery vs. 42.8% with SBRT; P < .001).
Implications
The findings indicate that the increasing use of SBRT among otherwise healthy individuals represents a potential loss in life-years for this patient population, according to a press release.
References:
- Surgical resection is associated with superior 5-year survival compared to stereotactic body radiotherapy for early-stage lung cancer in healthy patients (press release). Available at: https://www.aats.org/surgical-resection-is-associated-with-superior-5-year-survival-compared-to-stereotactic-body-radiotherapy-for-early-stage-lung-cancer-in-healthy-patients. Published May 1, 2023. Accessed May 17, 2023.
- Udelsman B, et al. Abstract 275. Presented at: American Association for Thoracic Surgery Annual Meeting; May 6-9, 2023; Los Angeles.
Collapse
Udelsman B, et al. Abstract 275. Presented at: American Association for Thoracic Surgery Annual Meeting; May 6-9, 2023; Los Angeles.
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