A propensity-matched analysis of surgery and stereotactic body radiotherapy for early stage non-small cell lung cancer in the elderly.

Medicine

PubMedID: 28033277

Wang P, Zhang D, Guo XG, Li XM, Du LH, Sun BJ, Fang XQ, Guo YH, Guo J, An L, Qu GP, Liu CT. A propensity-matched analysis of surgery and stereotactic body radiotherapy for early stage non-small cell lung cancer in the elderly. Medicine (Baltimore). 2016;95(52):e5723.
Elderly patients with early stage non-small cell lung cancer (NSCLC) who undergo surgical resection are at a high risk of treatment-related complications. Stereotactic body radiation therapy (SBRT) is considered an alternative treatment option with a favorable safety profile. Given that prospective comparative data on SBRT and surgical treatments are limited, we compared the 2 treatments for early stage NSCLC in the elderly. We retrospectively collected information from the database at our geriatric institution on patients with clinical stage IA/B NSCLC who were treated with surgery or SBRT. The patients were matched using a propensity score based on gender, age, T stage, tumor location, pulmonary function (forced expiratory volume in 1 second [FEV1]% and FEV1), Charlson comorbidity score, and World Health Organization performance score. We compared locoregional control rate, recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) between the 2 treatment cohorts before and after propensity score matching. A total of 106 patients underwent surgery, and 74 received SBRT. Surgical patients were significantly younger (72. 6?±?7. 9 vs 82. 6?±?4. 1 years, P?=?0. 000), with a significantly higher rate of adenocarcinoma (P?=?0. 000), better Eastern Cooperative Oncology Group performance scores (P?=?0. 039), and better pulmonary function test results (P?=?0. 034 for predicted FEV1 and P?=?0. 032 for FEV1). In an unmatched comparison, there were significant differences in locoregional control (P?=?0. 0012) and RFS (P?