Tumor Size, Histology, and Survival After Stereotactic Ablative Radiotherapy and Sublobar Resection in Node-negative Non-small Cell Lung Cancer
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Published on: February 12, 2017
Vignesh Raman1, Oliver K Jawitz1, Marcelo Cerullo1
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Background:
Although SABR is increasingly emerging as an alternative to surgery for node-negative non-small cell lung cancer, there is poor understanding of patients who may most benefit SABR compared to surgery.
Objective:
This study examined the relationship between tumor size and the comparative outcomes of SABR and sublobar resection in patients with node-negative non-small cell lung cancer.
Results:
A total of 59,949 patients met study criteria: 19,888 (33%) underwent SABR, 33,052 (55%) wedge resection, and 7009 (12%) segmental resection. In multivariable regression, a significant 3-way interaction was found between histology, tumor size, and type of treatment. After stratification by histology, a significant interaction between tumor size and treatment was preserved for patients with adenocarcinoma and squamous cell carcinoma. Sublobar resection was associated with greater survival compared to SABR for tumor sizes greater than 6 and 8 mm for patients with adenocarcinoma and squamous cell carcinoma, respectively. SABR was associated with similar survival compared to sublobar resection for patients with papillary and large cell histology.
Conclusions:
In this National Cancer Database analysis, sublobar resection was associated with greater survival compared to SABR for lesions >6or 8 mm in patients with adenocarcinoma or squamous cell carcinoma; however, SABR was associated with similar survival compared to sublobar resection in patients with aggressive tumors including papillary and large cell histology. Histologic diagnosis in patients with even small tumors may enable better treatment selection in those who cannot tolerate lobectomy.
Insights
Stereotactic ablative radiotherapy (SABR) outcomes vary by tumor size and histology in non-small cell lung cancer. Sublobar resection offers better survival for larger adenocarcinomas and squamous cell carcinomas, while SABR is comparable for aggressive histologies.
Area of Science:
- Thoracic Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Stereotactic ablative radiotherapy (SABR) is an emerging alternative to surgery for early-stage non-small cell lung cancer (NSCLC).
- Optimal patient selection for SABR versus surgical resection remains unclear, particularly concerning tumor characteristics.
- Understanding treatment benefits based on histology and tumor size is crucial for personalized NSCLC management.
Purpose of the Study:
- To investigate the relationship between tumor size and comparative outcomes of SABR and sublobar resection.
- To identify patient subgroups who may benefit most from SABR versus surgery in node-negative NSCLC.
Main Methods:
- Analysis of the National Cancer Database (NCDB) including 59,949 patients with node-negative NSCLC.
- Comparison of outcomes between SABR, wedge resection, and segmental resection.
- Multivariable regression analysis to assess interactions between histology, tumor size, and treatment type.
Main Results:
- A significant 3-way interaction between histology, tumor size, and treatment was observed.
- Sublobar resection showed superior survival compared to SABR for adenocarcinomas >6 mm and squamous cell carcinomas >8 mm.
- SABR demonstrated similar survival to sublobar resection for papillary and large cell lung cancer histologies.
Conclusions:
- Sublobar resection is associated with greater survival than SABR for larger tumors (>6 or 8 mm) in adenocarcinoma and squamous cell carcinoma.
- SABR offers comparable survival to sublobar resection in patients with aggressive tumor histologies (papillary and large cell).
- Histologic diagnosis is vital for optimizing treatment selection, especially for patients unsuitable for lobectomy.
