방사선종양학

본문글자크기
  • [J Clin Oncol.] Post-Treatment Mortality After Surgery and Stereotactic Body Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer.

    University of Colorado School of Medicine / Chad G. Rusthov*

  • 출처
    J Clin Oncol.
  • 등재일
    2018 Mar 1
  • 저널이슈번호
    36(7):642-651.
  • 내용

    바로가기  >

    Abstract

    Purpose

    In early-stage non-small cell lung cancer (NSCLC), post-treatment mortality may influence the comparative effectiveness of surgeryand stereotactic body radiotherapy (SBRT), with implications for shared decision making among high-risk surgical candidates. We analyzed early mortality after these interventions using the National Cancer Database.

    Patients and Methods

    We abstracted patients with cT1-T2a, N0, M0 NSCLC diagnosed between 2004 and 2013 undergoing either surgery or SBRT. Thirty-day and 90-day post-treatment mortality rates were calculated and compared using Cox regression and propensity score-matched analyses.

    Results

    We identified 76,623 patients who underwent surgery (78% lobectomy, 20% sublobar resection, 2% pneumonectomy) and 8,216 patients who received SBRT. In the unmatched cohort, mortality rates were moderately increased with surgery versus SBRT (30 days, 2.07% v 0.73% [absolute difference (Δ), 1.34%]; P < .001; 90 days, 3.59% v 2.93% [Δ, 0.66%]; P < .001). Among the 27,200 propensity score-matched patients, these differences increased (30 days, 2.41% v 0.79% [Δ, 1.62%]; P < .001; 90 days, 4.23% v 2.82% [Δ, 1.41%]; P < .001). Differences in mortality between surgery and SBRT increased with age, with interaction P < .001 at both 30 days and 90 days (71 to 75 years old: 30-day Δ, 1.87%; 90-day Δ, 2.02%; 76 to 80 years old: 30-day Δ, 2.80%; 90-day Δ, 2.59%; > 80 years old: 30-day Δ, 3.03%; 90-day Δ, 3.67%; all P ≤ .001). Compared with SBRT, surgical mortality rates were higher with increased extent of resection (30-day and 90-day multivariate hazard ratio for mortality: sublobar resection, 2.85 and 1.37; lobectomy, 3.65 and 1.60; pneumonectomy, 14.5 and 5.66; all P < 0.001).

     

    Fig 2. Unadjusted absolute mortality rates at (A) 30 days, and (B) 90 days by intervention type. SBRT, stereotactic body radiotherapy.

     

    Conclusion

    Differences in 30- and 90-day post-treatment mortality between surgery and SBRT increased as a function of age, with the largest differences in favor of SBRT observed among patients older than 70 years. These representative mortality data may inform shared decision making among patients with early-stageNSCLC who are eligible for both interventions.

     

     

    Author information

    Stokes WA1, Bronsert MR1, Meguid RA1, Blum MG1, Jones BL1, Koshy M1, Sher DJ1, Louie AV1, Palma DA1, Senan S1, Gaspar LE1, Kavanagh BD1, Rusthoven CG1.

    1 William A. Stokes, Michael R. Bronsert, Robert A. Meguid, Bernard L. Jones, Laurie E. Gaspar, Brian D. Kavanagh, and Chad G. Rusthoven, University of Colorado School of Medicine, Aurora; Matthew G. Blum, Memorial Hospital, Colorado Springs, CO; Matthew Koshy, University of Chicago School of Medicine, Chicago, IL; David J. Sher, University of Texas Southwestern School of Medicine, Dallas, TX; Alexander V. Louie and David A. Palma, London Health Sciences Centre, London, Ontario, Canada; and Suresh Senan, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands.

  • 덧글달기
    덧글달기
       IP : 3.80.24.244

    등록