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Prospective Cohort Study to Compare Long-term Lung Cancer-Specific and All-Cause Survival of Clinical Early Stage (T1a-b; ≤20mm) Non-Small-Cell Lung Cancer (NSCLC) Treated by Stereotactic Body Radiation Therapy (SBRT) and Surgery
（Journal of Thoracic Oncology；IF=20.4）
Claudia I. Henschke, Rowena Yip, Qi Sun, Pengfei Li, Andrew Kaufman, Robert Samstein, Cliff Connery, Leslie Kohman, Paul Lee, Henry Tannous, David Yankelevitz, Emanuela Taioli, Kenneth Rosenzweig, Raja Flores, for the I-ELCAP and IELCART Investigators
Introduction 研究目的
We aimed to compare outcomes of patients with first primary clinical T1a-bN0M0 non-small-cell-lung-cancer(NSCLC) treated with surgery or SBRT.
我们旨在比较接受手术或SBRT治疗的原发性临床T1a-bN0M0非小细胞肺癌（NSCLC）患者的结果。
Methods 研究方法
We identified patients with first primary clinical T1a-bN0M0 NSCLCs on last pre-treatment CT treated by surgery or SBRT in two prospective cohorts: International Early Lung Cancer Action Program(I-ELCAP) and Initiative for Early Lung Cancer Research on Treatment(IELCART). Lung-cancer-specific and all-cause-survival after diagnosis were compared using Kaplan-Meier analysis. Propensity score matching was used to balance baseline demographics and co-morbidities and analyzed using Cox proportional hazards regression.
在国际早期肺癌行动计划（I-ELCAP）和早期肺癌治疗研究倡议（IELCART）两个前瞻性队列中通过手术或SBRT治疗前最后一次CT确定了首次原发性临床T1a-bN0M0 NSCLC患者。用Kaplan-Meier分析比较肺癌特异性和全因生存率。倾向评分匹配用于平衡基线人口统计学数据和合并症，并使用Cox比例风险回归进行分析。
Results 研究结果
1115 NSCLC patients, 1003 had surgery and 112 had SBRT; 525 in I-ELCAP in 1992-2021, 590 in IELCART in 2016-2021. Median follow-up was 57.6 months. Ten-year-lung-cancer-specific- survival was not significantly different: 90%(95%CI:87-92%) vs. 88%(95%CI:77-99%);p=.55. Cox regression showed no significant difference in lung-cancer-specific-survival for the combined cohorts(p=0.48) or separately for I-ELCAP(p=1.00) and IELCART(p=1.00). While 10-year all-cause-survival was significantly different (75%vs.45%,p<.0001), after propensity score matching, all-cause-survival using Cox regression was no longer different for the combined cohorts(p=0.74), or separately for I-ELCAP(p=1.00) and IELCART(p=0.62).
1115名NSCLC患者，1003人接受了手术，112人接受了SBRT；1992-2021年I-ELCAP 525人，2016-2021年IELCART 590人。中位随访时间为57.6个月。十年肺癌特异性生存率无显著差异：90%（95%CI：87-92%）vs 88%（95%CI：77-99%）；P=.55。Cox回归结果显示，无论是I-ELCAP（P=1.00）还是IELCART（P=1.00），或合并队列（P=0.48）的肺癌特异性生存率均无明显差异。虽然10年全因生存率有显著差（75%vs.45%,p<.0001），但在倾向得分匹配后，使用Cox回归法计算的全因生存率在合并队列中不再有差异（p=0.74），在I-ELCAP（p=1.00）和IELCART（p=0.62）的单独队列中也不再有差异。
Conclusions 研究结论
This first prospectively collected cohort analysis of long-term survival of small, early NSCLCs demonstrated that lung-cancer-specific-survival was high for both treatments and not significantly different and also that all-cause-survival after propensity matching was not significantly different. This supports SBRT as an alternative treatment option for small, early NSCLCs which is especially important with their increasing frequency due to low-dose CT screening. Also treatment decisions are influenced by many different factors and should be personalized based on the unique circumstances of each patient.
这项首次对小型早期 NSCLC 长期存活率进行的前瞻性队列分析表明，两种治疗方法的肺癌特异性存活率都很高，且无显著差异，倾向匹配后的全因存活率也无显著差异。这支持将 SBRT 作为小型早期 NSCLC 的替代治疗方案，这在低剂量 CT 筛查导致 NSCLC 发生率增加的情况下尤为重要。此外，治疗决策还受到许多不同因素的影响，因此应根据每位患者的具体情况进行个性化治疗。
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