胸腔镜肺叶切除术与立体定向放疗治疗早期非小细胞肺癌的疗效比较

Comparison of the treatment outcomes between video-assisted thoracoscopic lobectomy and stereotactic body radiotherapy for early-stage non-small cell lung cancer

目的比较胸腔镜(VATS)肺叶切除术与立体定向放疗(SBRT)治疗早期非小细胞肺癌(NSCLC)患者的疗效。方法回顾性分析了2012年1月至2016年12月在浙江省肿瘤医院接受VATS肺叶切除术或SBRT的早期NSCLC患者。根据年龄、性别、卡氏评分(KPS)、查尔森合并症指数(CCI)、肺功能和肿瘤直径对两种治疗患者进行倾向评分匹配(PSM)。对两组符合要求的病例总生存率(OS)、癌症特异性生存率(CSS)、局部控制率(LRC)和无病生存率(DFS)进行对比分析。结果共纳入567例符合要求病例,其中VATS肺叶切除术458例,SBRT 109例。经倾向评分匹配后,每组分别纳入52例患者。中位随访时间44个月。手术组3年和5年的总生存率分别为94.2%和91.6%,SBRT组分别为88.6%和79.9%(P=0.097)。手术组和SBRT组的5年CSS差异无统计学意义(91.6%vs. 83.7%,P=0.270)。两组3年和5年期LRC相当(94.0%和85.9%vs.93.5%和93.5%,P=0.621)。两队列间5年DFS的差异无统计学意义(80.5%vs.79.0%,P=0.624)。手术组中,有5例患者(10%)出现≥3级治疗不良反应。1例患者术后30 d内因严重肺部感染导致的败血症死亡。SBRT组中,1例患者发生3级放射性肺炎,无4级或5级治疗相关不良反应。结论 SBRT或可作为代替VATS肺叶切除术治疗Ⅰ~Ⅱ期非小细胞肺癌的一种选择,但尚需进行随机试验进一步评估。

Objective To make comparisons of treatment outcomes between video-assisted thoracoscopic surgery(VATS)lobectomy and stereotactic body radiotherapy(SBRT)for early stage non-small cell lung cancer(NSCLC).Methods Overall survival(OS),cancer specific survival(CSS),locoregional control(LRC),and disease-free survival(DFS)were retrospectively compared between early stage NSCLC patients who underwent VATS lobectomy and SBRT at our institution from January 2012 to December 2016.Propensity score matching(PSM)was carried out to reduce selection bias between two groups based on age,gender,Karnofsky performance score(KPS),Charlson comorbidity index(CCI),pulmonary function,and tumor diameter.Results A total of 567 patients treated with VATS lobectomy(n=458)or SBRT(n=109)were included.104 patients were matched for further analysis(52 in VATS lobectomy group and 52 in SBRT group).The median follow-up time was 44 months.the 3-and 5-year OS were 94.2%and 91.6%for VATS lobectomy and 88.6%and 79.9%for SBRT(P=0.097),respectively.No statistically significant differences were noted in 5-year CSS(91.6%vs.83.7%,P=0.270).The cumulative incidence of LRC was comparable between two group(94.0%and 85.9%vs.93.5%and 93.5%at 3,5 years,P=0.621).Differences in the DFS were not statistically significant(80.5%and 79.0%at 5 years,P=0.624).In the VATS lobectomy group,10%patients(n=5)experienced≥grade 3 CTCAE toxicity.One patient died of septicemia due to severe lung infection within 30 d after VATS lobectomy.In the SBRT group,one patient suffered from grade 3 radiation pneumonitis.There were no grade 4 or 5 toxicities in SBRT group.Conclusions This propensity matched analysis suggests that SBRT can be an alternative option to VATS lobectomy for stageⅠ-ⅡNSCLC.Randomized trials are needed to evaluate the outcomes.