Abstract
PurposeIrradical resection of non-small-cell lung cancer (NSCLC) is a detrimental prognostic factor. Recently, Rasing et al. presented an internationally validated risk score for pre-treatment prediction of irradical resection. We hypothesized that chemoradiation therapy (CRT) could serve as an alternative approach in patients with a high risk score and compared overall survival (OS) outcomes between surgery and CRT.MethodsPatients from a population-based cohort with stage IIB–III NSCLC between 2015 and 2018 in The Netherlands were selected. Patients with a ‘Rasing score’ > 4 who underwent surgery were matched with patients who underwent CRT using 1:1 nearest-neighbor propensity score matching. The primary endpoint of OS was compared using a Kaplan–Meier analysis.ResultsIn total, 2582 CRT and 638 surgery patients were eligible. After matching, 523 well-balanced pairs remained. Median OS in the CRT group was 27.5 months, compared with 45.6 months in the surgery group (HR 1.44, 95% CI 1.23–1.70, p < 0.001). The 114 surgical patients who underwent an R1–2 resection (21.8%) had a worse median OS than the CRT group (20.2 versus 27.5 months, HR 0.77, 95% CI 0.61–0.99, p = 0.039).ConclusionIn NSCLC patients at high predicted risk of irradical resection, CRT appears to yield inferior survival compared with surgery. Therefore, choosing CRT instead of surgery cannot solely be based on the Rasing score. Since patients receiving an R1–2 resection do have detrimental outcomes compared with primary CRT, the treatment decision should be based on additional information, such as imaging features, comorbidities, patient preference, and the surgeon’s confidence in achieving an R0 resection.
Highlights
Lung cancer is the leading cause of cancer-related deaths in both men and women internationally.[1]
A total of 4876 patients treated with Chemoradiation therapy (CRT) for stage I–III Nonsmall-cell lung cancer (NSCLC) between 2015 and 2018 were identified
Standardized mean differences (SMD) were below the 0.1 threshold, indicating a well-balanced match
Summary
Lung cancer is the leading cause of cancer-related deaths in both men and women internationally.[1]. Irradical resection has been associated with hazard ratios (HRs) for death between 1.5 and 8.2 compared with radical resection.[4,5] Chemoradiation therapy (CRT) is the accepted alternative approach with curative intent in patients with locally advanced NSCLC who are deemed unresectable.[6,7]. Patients with a Rasing score [ 4 were deemed at high risk, as their individual predicted and observed probability of an R1–2 resection was[13% in all these patients, and 19% on average.[8]. We hypothesized that CRT could serve as an alternative approach in patients with a high risk of an irradical resection as predicted by the Rasing score.[8] the primary aim of this study was to compare overall survival (OS) between surgery and CRT in those patients. A secondary aim was to identify potentially varying OS outcomes for CRT versus surgery across different patient subgroups
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