Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Body Radiotherapy Treatment for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matching Analysis.

Baiqiang Dong,Baiqiang Dong,Jin Wang,Jin Wang,Fangxiao Lu,Xuan Zhu,Zekai Shu,Zekai Shu,Ming Chen,Ming Chen,Yongling Ji

doi:10.3389/fonc.2020.585709

Abstract

BackgroundCompared the overall outcomes of video-assisted thoracoscopic surgery (VATS) versus stereotactic body radiotherapy (SBRT) for stage I-II non-small cell lung cancer (NSCLC).MethodsWe retrospectively compared overall survival (OS), cancer-specific survival (CSS), locoregional control (LRC), and disease-free survival (DFS) at our institution between January 2012 and December 2016. Propensity score-matching was performed to reduce patient selection bias based on age, gender, Karnofsky performance score, Charlson comorbidity index, pulmonary function, and tumor diameter.ResultsA total of 567 patients treated with SBRT (n = 109) or surgery (n = 458) were included. Of those, 104 patients were matched for further analyses. Median follow-up was 44 months. At 3 and 5 years, OS was 88.6 and 79.9% for SBRT, and 94.2 and 91.6% for surgery (p = 0.097). There were no differences noted in 5-year CSS (83.7 vs. 91.6%, respectively; p = 0.270). The cumulative incidence of LRC at 3 and 5 years was comparable (93.5 and 93.5% vs. 94.0 and 85.9%, respectively; p = 0.621). Differences in the rates of disease-free survival at 5 years were not statistically significant (79.0 and 80.5%, respectively; p = 0.624).ConclusionsThis propensity score-matching analysis suggests that SBRT can be an alternative option to VATS lobectomy for stage I-II NSCLC.

Highlights

The early-stage lung cancer is an increasingly diagnosed disease owing to the widespread use of low-dose computed tomography (CT) screening into routine care [1, 2]
A total of 567 patients treated with stereotactic body radiotherapy (SBRT) (n = 109) or surgery (n = 458) were included
Differences in the rates of disease-free survival at 5 years were not statistically significant (79.0 and 80.5%, respectively; p = 0.624). This propensity score-matching analysis suggests that SBRT can be an alternative option to video-assisted thoracoscopic surgery (VATS) lobectomy for stage I-II non-small cell lung cancer (NSCLC)

Summary

Introduction

The early-stage lung cancer is an increasingly diagnosed disease owing to the widespread use of low-dose computed tomography (CT) screening into routine care [1, 2]. Lobectomy offers the best potential cure for operable patients with earlystage non-small cell lung cancer (NSCLC) [3, 4]. The minimally invasive video-assisted thoracoscopic surgery (VATS) has been associated with lower complication and faster functional recovery compared with open lobectomy; this approach has gained increasing attention in the previous decades [5,6,7,8]. By reducing the surgery-related physiologic insult, minimally invasive surgery expands the pool of operable patients who were previously considered potentially inoperable [9]. Compared the overall outcomes of video-assisted thoracoscopic surgery (VATS) versus stereotactic body radiotherapy (SBRT) for stage I-II non-small cell lung cancer (NSCLC)

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Results

Discussion

Conclusion