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| Propensity Matched Comparison of Surgery vs. Stereotactic Body Radiation Therapy in Early Stage Lung Cancer | |||||||||||||||||||||
Chadrick Denlinger, Jeffrey D. Bradley, Issam M. El Naqa, Jennifer B. Zoole, Bryan F. Meyers, Alec Patterson, Daniel Kreisel, Alexander S. Krupnick, Traves Crabtree; Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
Methods: We compared all patients treated with surgery (1/2000-12/2006) or SBRT (2/2004-5/2007) with IA/B NSCLC clinically staged by CT and PET. Comorbidity scores were recorded prospectively using the Adult Co-Morbidity Evaluation (ACE-27) scoring system. Charts were reviewed to determine local tumor recurrence, disease-specific and overall survival. A multivariable Cox proportional hazard model was utilized to adjust estimated treatment hazard ratios for confounding effects of patient age, comorbidity index, and clinical stage. Results: There were 462 surgery patients and 79 SBRT patients. Overall, surgical patients were older (p<0.001), had lower co-morbidity scores (p<0.001), and better pulmonary function (FEV1 and DLCO)(p<0.001). Among the surgical and SBRT groups, 62.6% (291/462) and 75.9% (60/79) were clinical stage IA, respectively. Final pathology upstaged 35% (62/462) of the surgery patients. In an unmatched comparison, overall 5-year survival was 55% with surgery, and the 3-year survival was 32% with SBRT. In clinical stage IA patients, 3-year local tumor control was 89% with SBRT and 96% with surgery (p=0.051). There was no difference in local tumor control in IB disease (p=0.893). In patients <75 years old, 3-year disease specific survival was 85% with surgery and 60% with SBRT(p=0.013), with no survival difference in patients >75(p=0.14). In clinical stage IA patients, 3-year disease specific survival with surgery was 85% vs. 71% with SBRT (p=0.04). No disease specific survival differences were found in patients with IB disease (p=0.69). Table 1 summarizes the regression analysis comparing local tumor control and survival between surgery and SBRT matched by age, comorbidity score, and tumor stage. Conclusion: In an unmatched comparison surgical patients were generally healthier and had better local tumor control and disease-specific survival in clinical stage IA vs. SBRT patients. Propensity regression analysis in clinical stage IA/B NSCLC revealed equivocal local recurrence and disease-specific survival between surgery and SBRT. Propensity Cox regression analysis of treatment modality (Surgery vs. SBRT)
*Adjusted for Age, Comorbidity score, and T-stage. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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