medwireNews: Curative-intent surgery for early-stage non-small-cell lung cancer (NSCLC) results in better long-term overall survival (OS) than stereotactic body radiotherapy (SBRT), particularly when combined with an appropriate degree of regional lymph node examination, researchers report.
Writing in JAMA Network Open, Alexander Chi (Marshfield Clinic, Wisconsin, USA) and co-authors say: “Although surgery’s superiority over SBRT has been corroborated in many studies, the influence of regional lymph node assessment on such comparisons has not, to our knowledge, been fully analyzed previously.”
They add that their 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.”
The US National Cancer Database study included 104,709 patients with stage T1–3, N0M0 NSCLC that was diagnosed between 2004 and 2014. Of these, 91,330 underwent either lobectomy (79.3%), wedge resection (14.6%), segmentectomy (3.4%), or pneumonectomy (2.6%). The majority of surgical patients also received some degree of lymph node examination, with 55.8%, 15.6%, and 14.2% having 1–10, 11–15, or more than 15 nodes examined, respectively.
The 5-year OS rates among the patients who underwent surgery ranged from 48.1% to 64.6%, depending on the type of surgery. Furthermore, the rates increased with the use of regional lymph node surgery such that patients with no lymph nodes examined had a 5-year OS rate of 50.2% compared with 62.9%, 65.3%, and 64.6% for 1–10, 11–15, and more than 15 nodes, respectively.
By comparison, the 5-year OS rate among the 13,379 patients who received SBRT was 30.4%.
After adjustment for potential confounders such as sex, race, tumor size, systemic therapy, and insurance status, all surgical treatments were associated with a significantly lower risk for mortality relative to SBRT, with hazard ratios (HRs) of 0.53 for lobectomy, 0.60 for segmentectomy, 0.67 for wedge resection, and 0.75 for pneumonectomy.
In addition, examination of either 11–15 lymph nodes, or 15 or more lymph nodes was associated with a significantly lower risk for death than examination of no lymph nodes (HR=0.73 for both).
The researchers also conducted a number of subgroup analyses stratified by age, clinical T stage, and the number of lymph nodes examined. These analyses revealed that pneumonectomy was only associated with reduced mortality risk when at least one lymph node was examined overall and when fewer than 15 nodes were examined for stage T1 disease in patients younger than 80 years.
In addition, no patients aged 80 years or older derived greater survival benefit from pneumonectomy relative to SBRT, which the researchers suggest is due to an “increased likelihood of frailty and comorbidities.”
They add: “As a result, SBRT may be a reasonable alternative treatment in these situations.”
Chi et al conclude: “Overall, our findings are consistent with previous studies and the [current] guidelines, which support lobectomy with adequate regional lymph node assessment to be the standard of care in operable patients with ES NSCLC.”
By Laura Cowen
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