| Autor: |
Michael J. Littau, BA, Richard Freeman, MD, MBA, Wickii T. Vigneswaran, MD, MBA, Fred A. Luchette, MD, MSc, Marshall S. Baker, MD, MBA, Wissam Raad, MD, Zaid M. Abdelsattar, MD, MSc, Tyler Grenda, MD, MS, James Lubawski, MD, Maria Lucia L. Madariaga, MD |
| Jazyk: |
angličtina |
| Rok vydání: |
2022 |
| Předmět: |
|
| Zdroj: |
JTCVS Open, Vol 9, Iss , Pp 249-261 (2022) |
| Druh dokumentu: |
article |
| ISSN: |
2666-2736 |
| DOI: |
10.1016/j.xjon.2021.09.052 |
| Popis: |
Objectives: Stereotactic body radiation therapy (SBRT) is an established primary treatment modality in patients with lung cancer who have multiple comorbidities and/or advanced-stage disease. However, its role in otherwise healthy patients with stage I lung cancer is unclear. In this context, we compared the effectiveness of SBRT versus surgery on overall survival using a national database. Methods: We identified all patient with clinical stage I non–small cell lung cancer from the National Cancer Database from 2004 to 2016. We defined otherwise healthy patients as those with a Charlson-Deyo comorbidity index of 0 and whose treatment plan included options for either SBRT or surgery. We further excluded patients who received SBRT due to a contraindication to surgery. We first used propensity score matching and Cox proportional hazard models to identify associations. Next, we fit 2-stage residual inclusion models using an instrumental variables approach to estimate the effects of SBRT versus surgery on long-term survival. We used the hospital SBRT utilization rate as the instrument. Results: Of 25,963 patients meeting all inclusion/exclusion criteria, 5465 (21%) were treated with SBRT. On both Cox proportional hazards modeling and propensity-score matched Kaplan-Meier analysis, surgical resection was associated with improved survival relative to SBRT. In the instrumental-variable–adjusted model, SBRT remained associated with decreased survival (hazard ratio, 2.64; P |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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