방사선의학 웹진

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Abstract
Background: With rising life expectancy and widespread lung cancer screening, early-stage non-small cell lung cancer (NSCLC) incidence has increased. While surgery is the standard treatment for operable stage I NSCLC, many patients are ineligible due to age or comorbidities. Stereotactic body radiotherapy (SBRT) has achieved good primary tumor control rates and overall survival. This study compares the outcomes of SBRT and surgery for stage I NSCLC using propensity score overlap-weighted dataset. Methods: This retrospective study analyzed clinical stage I NSCLC patients treated at a tertiary hospital from 2012 to 2021. Baseline differences between SBRT and surgery groups were adjusted using overlap weighting. AI-based CT analysis (CT AI-CAD) assessed tumor characteristics, verified by radiologists. Primary outcomes were 5-year cumulative incidence of recurrence and overall survival, with subgroup analyses based on tumor features. Results: Of 1474 patients, 1258 underwent surgery, and 216 received SBRT. After overlap weighting, baseline characteristics were well balanced. The 5-year cumulative incidence of recurrence and OS showed no statistically significant differences between SBRT and surgery groups (recurrence: 16.2% vs. 16.1%; OS: 80.5% vs. 82.9%). Further AI-based CT subgroup analysis showed no significant differences in recurrence rates across tumor features. A solid tumor diameter associated with a significant increase in recurrence was identified as 16.6 mm for SBRT and 18.6 mm for surgery. Conclusions: After overlap weighting, SBRT and surgery showed no statistically significant differences in treatment outcomes in stage I NSCLC. These findings may help guide the timing and selection of safe and effective treatment approaches.

Figure 2는 Overlap Weighting 후 체부정위방사선치료(SBRT)군과 수술군 간의 5년 재발률(A, B)과 전체 생존율(C, D)을 비교한 Kaplan-Meier 곡선입니다. 두 군 간의 5년 재발률은 16.2% vs. 16.1%, 전체 생존율은 80.5% vs. 82.9%로 유의한 차이가 없었으며, 이는 SBRT가 수술의 실질적 대안이 될 수 있음을 시사합니다. 이 분석은 AI 기반 영상분석을 포함한 다변량 요인 보정을 거쳐 이루어진 결과로, 임상적 타당성과 재현성이 높습니다.

Affiliations

Eun Hye Lee 1, Young Joo Suh 2, Jong Won Park 3, Jisu Moon 4, Sangjoon Park 3, Chang Geol Lee 3, Hong In Yoon 3, Byung Jo Park 5, Jin Gu Lee 5, Dae Joon Kim 5, Seung Hyun Yong 6, Sang Hoon Lee 6, Chang Young Lee 5, Jaeho Cho 3, Eun Young Kim 6
1Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea.
2Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
3Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
4BIostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
5Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.