Skip to main content

Advertisement

SpringerLink
Log in

Surgery or stereotactic body radiotherapy for metachronous primary lung cancer? A propensity score matching analysis

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

We compared outcomes after surgery or stereotactic body radiotherapy (SBRT) among patients with metachronous primary lung cancer (MPLC).

Methods

Patients with MPLC were treated with either surgery (2008–2018) or SBRT (2010–2018). We used propensity score matching (PSM) to reduce bias from various clinicopathological factors. MPLC was defined by the Martini and Melamed criteria.

Results

Of 77 patients, 51 underwent surgery and 26 received SBRT. Most median clinicopathological characteristics did not significantly differ between the surgery and SBRT groups (male sex: 67% vs 65%; age: 73 vs 77 years; time after first surgery: 6.2 vs 4.7 years; lobectomy as first procedure: 82% vs 85%; second tumor size: 11 vs 12 mm; clinical stage I: 96% vs 100%; CEA: 2.9 vs 3.0 ng/ml). However, the surgery group had significantly more ipsilateral second tumors (n = 71, 58%, P = 0.003), better performance status (P = 0.03), and preserved lung function (P = 0.02). Surgery, thus, tended to be selected for patients with good physical function and for the MPLC in the contralateral side. Five-year overall survival did not significantly differ between the surgery and SBRT groups, either before PSM (86.5% vs 65.8%, P = 0.24, log-rank) or after PSM (100% vs 84.4%, P = 0.73).

Conclusions

Surgery and SBRT for MPLC patients are safe and feasible treatments with similar outcomes. However, this finding should be verified by a random controlled trial with a larger study cohort.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Okami J, Shintani Y, Okumura M, Ito H, Ohtsuka T, Toyooka S, et al. Demographics, safety and quality, and prognostic information in both the seventh and eighth editions of the TNM Classification in 18,973 surgical cases of the Japanese Joint Committee of Lung Cancer Registry Database in 2010. J Thorac Oncol. 2019;14:212–22.

    Article  Google Scholar 

  2. National Lung Screening Trial Research T, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409.

    Article  Google Scholar 

  3. Blom EF, Haaf KT, De Koning HJ. Trends in lung cancer risk and screening eligibility affect overdiagnosis estimates. Lung Cancer. 2020;139:200–6.

    Article  Google Scholar 

  4. Tanoue LT, Tanner NT, Gould MK, Silvestri GA. Lung cancer screening. Am J Respir Crit Care Med. 2015;191:19–33.

    Article  Google Scholar 

  5. Cao C, Wang D, Chung C, Tian D, Rimner A, Huang J, et al. A systematic review and meta-analysis of stereotactic body radiation therapy versus surgery for patients with non-small cell lung cancer. J Thorac Cardiovasc Surg. 2019;157:362–73.

    Article  Google Scholar 

  6. Hamaji M, Ali SO, Burt BM. A meta-analysis of resected metachronous second non-small cell lung cancer. Ann Thorac Surg. 2015;99:1470–8.

    Article  Google Scholar 

  7. Jiang L, He J, Shi X, Shen J, Liang W, Yang C, et al. Prognosis of synchronous and metachronous multiple primary lung cancers: systematic review and meta-analysis. Lung Cancer. 2015;87:303–10.

    Article  Google Scholar 

  8. Loukeri AA, Kampolis CF, Ntokou A, Tsoukalas G, Syringos K. Metachronous and synchronous primary lung cancers: diagnostic aspects, surgical treatment, and prognosis. Clin Lung Cancer. 2015;16:15–23.

    Article  Google Scholar 

  9. Chen C, Huang X, Peng M, Liu W, Yu F, Wang X. Multiple primary lung cancer: a rising challenge. J Thorac Dis. 2019;11(supple 4):S523–S536536.

    Article  Google Scholar 

  10. Chang JY, Senan S, Paul MA, Mehran RJ, Luie AV, Balter P, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomized trial. Lancet Oncol. 2015;16:630–7.

    Article  Google Scholar 

  11. Stokes WA, Bronsert MR, Meguid RA, Blum MG, Jones BL, Koshy M, et al. Post-treatment mortality after surgery and stereotactic body radiotherapy for early-stage non-small cell lung cancer. J Clin Oncol. 2018;36:642–51.

    Article  Google Scholar 

  12. Muranishi Y, Sonobe M, Hamaji M, Kawagushi A, Hijiya K, Motoyama H, et al. Surgery for metachronous second primary lung cancer versus surgery for primary lung cancer: a propensity score-matched comparison of postoperative complications and survival outcomes. Interact Cardiovasc Thorac Surg. 2018;26:631–7.

    Article  Google Scholar 

  13. Hamaji M, Allen MS, Cassivi SD, Deschamps C, Nichols FC, Wigle DA, et al. Surgical treatment of metachronous second primary lung cancer after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013;145:683–91.

    Article  Google Scholar 

  14. Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 non-small cell lung cancer: Japan Clinical Oncology Group Study JCOG0403. Int J Radiat Oncol Biol Phys. 2015;93:989–96.

    Article  Google Scholar 

  15. Timmerman RD, Paulus R, Pass HI, Gore EM, Edelman MJ, et al. Stereotactic body radiation therapy for operable early-stage lung cancer: findings from the NRG Oncology RTOG 0618 Trial. JAMA Oncol. 2018;9:1263–6.

    Article  Google Scholar 

  16. Miyazaki T, Yamazaki T, Nakamura D, Sato S, Yamasaki N, Tsuchiya T, et al. Surgery or stereotactic body radiotherapy for elderly stage I lung cancer?: A propensity score matching analysis. Surg Today. 2017;47:1476–83.

    Article  Google Scholar 

  17. Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Caridiovasc Surg. 1975;70:606–12.

    Article  CAS  Google Scholar 

  18. Wang Y, Yeung JC, Hanna WC, Allision F, Paul NS, Waddell TK, et al. Metachronous or synchronous primary lung cancer in the era of computed tomography surveillance. J Thorac Cardiovasc Surg. 2019;157:1196–202.

    Article  Google Scholar 

  19. Jaklitsch MT, Jacobson FL, Austin JH, Field JK, Jett JR, Keshavjee S, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012;144:33–8.

    Article  Google Scholar 

  20. Mimae T, Okada M (2019) Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer? Gen Thorac Cardiovasc Surg. https://doi.org/10.1007/s11748-019-01219-y

    Article  PubMed  Google Scholar 

  21. Takahashi N, Sawabata N, Kawamura M, Ohtsuka T, Horio H, Sakaguchi H, et al. Multicenter prospective study of sublobar resection for c-stage I non-small cell lung cancer patients unable to undergo lobectomy (KLSG-0801): complete republication. Gen Thorac Cardiovasc Surg. 2016;64:470–5.

    Article  Google Scholar 

  22. Tamura M, Matsumoto I, Tanaka Y, Saito D, Yoshida S, Kakegawa S, et al. Comparison between stereotactic radiotherapy and sublobar resection for non-small cell lung cancer. Ann Thorac Surg. 2019;107:1544–50.

    Article  Google Scholar 

  23. Berman AT, Jabbour SK, Vachani A, Robinson C, Choi I, Mohindra P, et al. Empiric radiotherapy for Lung Cancer Collaborative Group multi-institutional evidence-based guidelines for the use of empiric stereotactic body radiation therapy for non-small cell lung cancer without pathologic confirmation. Transl Lung Cancer Res. 2019;8:5–14.

    Article  Google Scholar 

  24. Inoue T, Katoh N, Ito YM, Kimura T, Nagata Y, Kuriyama K, et al. Stereotactic body radiotherapy to treat small lung lesions clinically diagnosed as primary lung cancer by radiological examination: a prospective observational study. Lung Cancer. 2018;122:107–12.

    Article  Google Scholar 

  25. Kakinuma R, Noguchi M, Ashizawa K, Kuriyama K, Meshima A, Koizumi N, et al. Natural history of pulmonary subsolid nodules: a prospective multicenter study. J Thorac Oncol. 2016;11:1012–28.

    Article  Google Scholar 

  26. Arai J, Tsuchiya T, Oikawa M, Mochinaga K, Hayashi T, Yoshiura KI, et al. Clinical and molecular analysis of synchronous double lung cancers. Lung cancer. 2012;77:281–7.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Takuro Miyazaki, Tomoshi Tsuchiya, Keitaro Matsumoto, Go Hatachi, Ryoichiro Doi, Hironosuke Watanabe, Takaaki Nakatsukasa & Takeshi Nagayasu

  2. Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Takuya Yamazaki

  3. Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan

    Shuntaro Sato

Authors
  1. Takuro Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takuya Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuntaro Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomoshi Tsuchiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keitaro Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Go Hatachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryoichiro Doi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hironosuke Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takaaki Nakatsukasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takeshi Nagayasu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takuro Miyazaki.

Ethics declarations

Conflict of interest

Takuro Miyazaki and other co-authors have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miyazaki, T., Yamazaki, T., Sato, S. et al. Surgery or stereotactic body radiotherapy for metachronous primary lung cancer? A propensity score matching analysis. Gen Thorac Cardiovasc Surg 68, 1305–1311 (2020). https://doi.org/10.1007/s11748-020-01394-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-020-01394-3

Keywords

Search

Navigation