Long term survival with stereotactic ablative radiotherapy (SABR) versus thoracoscopic sublobar lung resection in elderly people: national population based study with propensity matched comparative analysis

Objectives To compare cancer specific survival after thoracoscopic sublobar lung resection and stereotactic ablative radiotherapy (SABR) for tumors ≤2 cm in size and thoracoscopic resection (sublobar resection or lobectomy) and SABR for tumors ≤5 cm in size.Design National population based retrospec...

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Bibliographic Details
Published in:BMJ (Online) 2016-07, Vol.354, p.i3570-i3570
Main Authors: Paul, Subroto, Lee, Paul C, Mao, Jialin, Isaacs, Abby J, Sedrakyan, Art
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - surgery
Age Factors
Aged
Aged, 80 and over
Cancer therapies
Carcinoma, Squamous Cell - mortality
Carcinoma, Squamous Cell - surgery
Epidemiology
Female
Follow-Up Studies
Health maintenance organizations
HMOs
Humans
Lung cancer
Lung Neoplasms - mortality
Lung Neoplasms - surgery
Male
Matched-Pair Analysis
Medicare
Morbidity
Mortality
Ostomy
Patients
Pneumonectomy - methods
Population
Postoperative period
Propensity Score
Radiation therapy
Radiosurgery
Retrospective Studies
SEER Program
Studies
Surgery
Surveillance
Survival Analysis
Thoracic Surgery, Video-Assisted
Treatment Outcome
Tumors
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Summary:Objectives To compare cancer specific survival after thoracoscopic sublobar lung resection and stereotactic ablative radiotherapy (SABR) for tumors ≤2 cm in size and thoracoscopic resection (sublobar resection or lobectomy) and SABR for tumors ≤5 cm in size.Design National population based retrospective cohort study with propensity matched comparative analysis.Setting Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare database in the United States.Participants Patients aged ≥66 with lung cancer undergoing SABR or thoracoscopic lobectomy or sublobar resection from 1 Oct 2007 to 31 June 2012 and followed up to 31 December 2013.Main outcome measures Cancer specific survival after SABR or thoracoscopic surgery for lung cancer.Results 690 (275 (39.9%) SABR and 415 (60.1%) thoracoscopic sublobar lung resection) and 2967 (714 (24.1%) SABR and 2253 (75.9%) thoracoscopic resection) patients were included in primary and secondary analyses. The average age of the entire cohort was 76. Follow-up of the entire cohort ranged from 0 to 6.25 years, with an average of three years. In the primary analysis of patients with tumors sized ≤2 cm, 37 (13.5%) undergoing SABR and 44 (10.6%) undergoing thoracoscopic sublobar resection died from lung cancer, respectively. The cancer specific survival diverged after one year, but in the matched analysis (201 matched patients in each group) there was no significant difference between the groups (SABR v sublobar lung resection mortality: hazard ratio 1.32, 95% confidence interval 0.77 to 2.26; P=0.32). Estimated cancer specific survival at three years after SABR and thoracoscopic sublobar lung resection was 82.6% and 86.4%, respectively. The secondary analysis (643 matched patients in each group) showed that thoracoscopic resection was associated with improved cancer specific survival over SABR in patients with tumors sized ≤5 cm (SABR v resection mortality: hazard ratio 2.10, 1.52 to 2.89; P
ISSN:1756-1833
0959-8138
1756-1833
DOI:10.1136/bmj.i3570