Comparison of Long-term Survival of Patients With Early-Stage Non–Small Cell Lung Cancer After Surgery vs Stereotactic Body Radiotherapy | Lung Cancer | JAMA Network Open | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.207.108.182. Please contact the publisher to request reinstatement.
[Skip to Navigation Landing]
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 5,538
    Citations 0
    Original Investigation
    Oncology
    November 20, 2019

    Comparison of Long-term Survival of Patients With Early-Stage Non–Small Cell Lung Cancer After Surgery vs Stereotactic Body Radiotherapy

    Author Affiliations
    • 1Marshfield Clinic, Marshfield, Wisconsin
    • 2West Virginia Clinical and Translational Science Institute, Erma Byrd Biomedical Research Center, West Virginia University Health Sciences Center, Morgantown
    • 3Department of Biostatistics, West Virginia University Health Sciences Center, Morgantown
    JAMA Netw Open. 2019;2(11):e1915724. doi:10.1001/jamanetworkopen.2019.15724
    Key Points español 中文 (chinese)

    Question  How does the long-term survival after curative-intent surgery with regional lymph node examination of various extents compare with long-term survival after stereotactic body radiotherapy for early-stage non–small cell lung cancer?

    Findings  In this cohort study of 104 709 patients in the US National Cancer Database with early-stage non–small cell lung cancer, those who received surgery coupled with regional lymph node examination of an appropriate extent had significantly better long-term survival than those who received stereotactic body radiotherapy.

    Meaning  These findings suggest that curative-intent surgery, when coupled with regional lymph node examination, is generally associated with the best long-term overall survival in patients with early-stage non–small cell lung cancer.

    Abstract

    Importance  Previous comparisons of surgery and stereotactic body radiotherapy (SBRT) for early-stage (ES) non–small cell lung cancer (NSCLC) did not account for the extent of regional lymph node examination (LNE) during surgery.

    Objective  To compare long-term overall survival (OS) of patients with ES NSCLC after surgery vs SBRT when the extent of regional LNE in patients undergoing surgery is thoroughly considered.

    Design, Setting, and Participants  Cohort study with survival comparisons using the multivariable Cox proportional hazards model and after propensity score matching. Data from the National Cancer Database were analyzed from October 28, 2018, through April 18, 2019. Patients with ES NSCLC diagnosed between January 1, 2004, and December 31, 2015, who underwent any curative-intent surgery or SBRT were included.

    Main Outcomes and Measures  Long-term OS.

    Results  Of 104 709 total patients, 91 330 underwent surgery (42 508 [46.5%] male; median [interquartile range] age, 68 [61-75] years) and 13 379 received SBRT (6065 [45.3%] male; median [interquartile range] age, 75 [68-81] years). Surgery, especially lobectomy (hazard ratio [HR], 0.53; 95% CI, 0.50-0.56), and regional LNE, especially when more than 10 lymph nodes were examined (HR, 0.73; 95% CI, 0.69-0.77), were associated with better long-term OS (P < .001). Pneumonectomy was not associated with reduced mortality risk when 0 nodes were examined (HR for stage T1, 1.43; 95% CI, 0.67-3.06; P = .35; HR for stage T2-T3, 0.62; 95% CI, 0.34-1.13; P = .12) or when more than 15 nodes were examined for stage T1 disease in patients younger than 80 years (HR, 0.77; 95% CI, 0.54-1.09; P = .14) or when patients aged 80 years or older received regional LNE of any extent (>15 nodes examined: HR for stage T1, 0.65; 95% CI, 0.16-2.64; P = .54; HR for stage T2-T3, 0.90; 95% CI, 0.50-1.60; P = .71). Less extensive surgery was not associated with improved OS when 0 nodes were examined in patients aged 80 years or older with stage T2 to T3 tumors (HR for lobectomy, 0.90; 95% CI, 0.65-1.25; P = .53) and in selected operable patients older than 75 years with stage T1 tumors (HR for lobectomy, 1.07; 95% CI, 0.57-2.00; P = .84).

    Conclusions and Relevance  This study found that, overall, surgery coupled with regional LNE of appropriate extent was associated with the best long-term OS in patients with ES NSCLC.

    ×