Abstract
Introduction Surgery is the standard of care for early-stage lung cancer, with stereotactic ablative body radiotherapy (SABR) a lower morbidity alternative for patients with limited physiological reserve. Comparisons of outcomes between these treatment options are limited by competing comorbidities and differences in pre-treatment pathological information. This study aims to address these issues by assessing both overall and cancer-specific survival for presumed stage I lung cancer on an intention-to-treat basis.
Methods This retrospective intention-to-treat analysis identified all patients treated for presumed stage I lung cancer within a single large UK centre. Overall survival, cancer-specific survival, and combined cancer and treatment-related survival were assessed with adjustment for confounding variables using Cox proportional hazards and Fine–Gray competing risks analyses.
Results 468 patients (including 316 surgery and 99 SABR) were included in the study population. Compared with surgery, SABR was associated with inferior overall survival on multivariable Cox modelling (SABR HR 1.84 (95% CI 1.32–2.57)), but there was no difference in cancer-specific survival (SABR HR 1.47 (95% CI 0.80–2.69)) or combined cancer and treatment-related survival (SABR HR 1.27 (95% CI 0.74–2.17)). Combined cancer and treatment-related death was no different between SABR and surgery on Fine–Gray competing risks multivariable modelling (subdistribution hazard 1.03 (95% CI 0.59–1.81)). Non-cancer-related death was significantly higher in SABR than surgery (subdistribution hazard 2.16 (95% CI 1.41–3.32)).
Conclusion In this analysis, no difference in cancer-specific survival was observed between SABR and surgery. Further work is needed to define predictors of outcome and help inform treatment decisions.
Abstract
No difference seen in cancer- and treatment-specific survival following surgery and SABR. Inferior overall survival may reflect unobserved confounding. Further prospective work should assess quality of life outcomes to support shared decision making. http://ow.ly/7s5t30njP0B
Footnotes
This article has supplementary material available from erj.ersjournals.com
Conflict of interest: K.L. Spencer has nothing to disclose.
Conflict of interest: M.P.T. Kennedy has nothing to disclose.
Conflict of interest: K.L. Lummis has nothing to disclose.
Conflict of interest: D.A.B. Ellames has nothing to disclose.
Conflict of interest: M. Snee has nothing to disclose.
Conflict of interest: A. Brunelli has nothing to disclose.
Conflict of interest: K. Franks reports personal fees for advisory board work from Pfizer and BMS, personal fees for advisory board work and support for conference attendance from AstraZeneca, and personal fees for educational meetings and support for conference attendance from Boehringer Ingelheim, outside the submitted work.
Conflict of interest: M.E.J. Callister has nothing to disclose.
Support statement: K.L. Spencer was supported by a Wellcome Trust grant and Medical Research Council fellowship (MR/N021339/1) during this project. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received August 17, 2018.
- Accepted December 31, 2018.
- Copyright ©ERS 2019