Kimberly J. Song, Isaac Faith, Stephanie Tuminello, Emanuela Taioli, Kenneth Rosenzweig, Raja M. Flores
{"title":"Patients With Surgically Resectable Lung Cancer Who Opt for Radiation Have Worse Outcomes","authors":"Kimberly J. Song, Isaac Faith, Stephanie Tuminello, Emanuela Taioli, Kenneth Rosenzweig, Raja M. Flores","doi":"10.1002/jso.27873","DOIUrl":null,"url":null,"abstract":"BackgroundSurgery has been the standard procedure for resectable primary LC. Survival after stereotactic body radiation therapy, another treatment, is significantly biased due to preponderance of data from patients deemed unsuitable for surgery. We examined survival of patients <jats:italic>refusing</jats:italic> surgery in favor of radiation therapy.MethodsWe used the Surveillance, Epidemiology, and End Results database to identify patients with primary Stage I NSCLC diagnosed between 2007 and 2016. Patients were excluded if it was unknown if they were recommended for surgery or if surgery was contraindicated. Multiple predictors were assessed: radiation versus surgery, age at diagnosis, sex, race/ethnicity, health insurance status, marital status, tumor size, and histology. A multivariate analysis was performed to estimate hazard ratios and generate Kaplan−Meier survival curves.ResultsWhen adjusted for confounding variables, survival was greater for patients undergoing surgical resection than those refusing surgery in favor of radiation (HR<jats:sub>adj</jats:sub> 2.66; 95% CI: 2.27−3.11, <jats:italic>p</jats:italic> < 0.001) or for those receiving no standardized treatment (HR<jats:sub>adj</jats:sub> 4.43; 95% CI: 3.57−5.50, <jats:italic>p</jats:italic> < 0.001).ConclusionsSBRT is an effective treatment for inoperable early LC but there is limited data comparing outcomes against surgical resection. When eligible for both, patients refusing surgery and choosing radiation had worse survival when adjusting for variables including age, tumor size, and histology, and suggests that surgical resection is a superior treatment modality.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.27873","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
BackgroundSurgery has been the standard procedure for resectable primary LC. Survival after stereotactic body radiation therapy, another treatment, is significantly biased due to preponderance of data from patients deemed unsuitable for surgery. We examined survival of patients refusing surgery in favor of radiation therapy.MethodsWe used the Surveillance, Epidemiology, and End Results database to identify patients with primary Stage I NSCLC diagnosed between 2007 and 2016. Patients were excluded if it was unknown if they were recommended for surgery or if surgery was contraindicated. Multiple predictors were assessed: radiation versus surgery, age at diagnosis, sex, race/ethnicity, health insurance status, marital status, tumor size, and histology. A multivariate analysis was performed to estimate hazard ratios and generate Kaplan−Meier survival curves.ResultsWhen adjusted for confounding variables, survival was greater for patients undergoing surgical resection than those refusing surgery in favor of radiation (HRadj 2.66; 95% CI: 2.27−3.11, p < 0.001) or for those receiving no standardized treatment (HRadj 4.43; 95% CI: 3.57−5.50, p < 0.001).ConclusionsSBRT is an effective treatment for inoperable early LC but there is limited data comparing outcomes against surgical resection. When eligible for both, patients refusing surgery and choosing radiation had worse survival when adjusting for variables including age, tumor size, and histology, and suggests that surgical resection is a superior treatment modality.
期刊介绍:
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.