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Surgery versus stereotactic body radiotherapy for clinical stage I non-small-cell lung cancer: propensity score-matching analysis including the ratio of ground glass nodules

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Abstract

Purpose

To investigate whether surgery and stereotactic body radiotherapy (SBRT) yield comparable outcomes for clinical stage (c-stage) I non-small-cell lung cancer (NSCLC), propensity score-matching (PSM) analysis was conducted.

Methods

This single-institutional retrospective study included patients who underwent surgery (n = 574) or SBRT (n = 182) between 2004 and 2014. PSM was performed based on tumor diameter, age, sex, performance status, forced expiratory volume, Charlson comorbidity index, and ground glass nodules (GGN) defined as cTis or cT1mi according to the 8th TNM classification.

Results

The median follow-up durations for the surgery and SBRT groups were 66 and 69 months, respectively. The multivariate analysis revealed that non-GGN was a significant factor for poorer overall survival (OS) and disease-free survival (DFS): hazard ratio (HR) 19.95% confidence interval (CI) 4.7–79, P < 0.001; and HR 28, 95% CI 6.9–110, P < 0.001, respectively. PSM identified 120 patients from each group. The 5-year OS and DFS rates of the surgery vs SBRT groups were 71% (95% CI 61–79) vs 64% (95% CI 54–72) (P = 0.41) and 63% (95% CI 53–72) vs 55% (95% CI 45–63) (P = 0.23) after PSM, respectively.

Conclusion

The PSM analyses including the ratio of GGN demonstrated that the OS and DFS for patients with c-stage I NSCLC in the surgery group were slightly superior to those for those in the SBRT group, although both survivals were not significantly different between the two therapeutic approaches.

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Availability of data and material

The data supporting this study are available on request from the corresponding author. The data are not publicity available due to restrictions, e.g. their containing information that may compromise the privacy of the participants.

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Funding

This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant no. 19K08183.

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Authors and Affiliations

  1. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    N. Tomita & Y. Shibamoto

  2. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    K. Okuda & R. Nakanishi

  3. Clinical Research Management Center, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    S. Osaga

  4. Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

    A. Miyakawa

Authors
  1. N. Tomita
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Contributions

NT, KO, and SO designed the study. NT, KO, AM, RN, and YS collected the data. NT and SO analyzed the data. NT and SO wrote the manuscript. NT, KO, SO, and YS edited the manuscript.

Corresponding author

Correspondence to N. Tomita.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study followed the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This study was performed after approval by the institutional review board of Nagoya City University Graduate School of Medical Sciences (approval number: 60–18-0108). As the requirement for written informed consent was waived due to the retrospective nature of this study, the research content was disclosed in the form of opt-out on the website.

Informed consent

As the requirement for written informed consent was waived due to the retrospective nature of this study, the research content was disclosed in the form of opt-out on the website.

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Tomita, N., Okuda, K., Osaga, S. et al. Surgery versus stereotactic body radiotherapy for clinical stage I non-small-cell lung cancer: propensity score-matching analysis including the ratio of ground glass nodules. Clin Transl Oncol 23, 638–647 (2021). https://doi.org/10.1007/s12094-020-02459-8

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