Spencer, KL orcid.org/0000-0002-6846-4341, Kennedy, MPT, Lummis, KL et al. (5 more authors) (2019) Surgery or radiotherapy for stage I lung cancer? An intention-to-treat analysis. European Respiratory Journal, 53 (6). 1801568. ISSN 0903-1936
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Copyright © ERS 2019. This is an author produced version of a paper published in European Respiratory Journal. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Lung cancer; Surgery; Stereotactic radiotherapy |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cancer and Pathology (LICAP) > Clinical Cancer Research (Leeds) |
Funding Information: | Funder Grant number MRC MR/N021339/1 |
Depositing User: | Symplectic Publications |
Date Deposited: | 03 Jan 2019 15:48 |
Last Modified: | 11 Jan 2020 01:39 |
Status: | Published |
Publisher: | European Respiratory Journal |
Identification Number: | 10.1183/13993003.01568-2018 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:140433 |