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
Menée auprès de 1 115 patients atteints d'un cancer du poumon non à petites cellules de stade T1a-bN0M0 (durée médiane de suivi : 57,6 mois), cette étude analyse la survie après un traitement par chirurgie ou par radiothérapie stéréotaxique
Introduction: We aimed to compare outcomes of patients with first primary clinical T1a-bN0M0 non-small-cell-lung-cancer(NSCLC) treated with surgery or SBRT. Methods: 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. Results: 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). Conclusions: 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.