Survival Following Sublobar Resection for Early-Stage Non-Small Cell Lung Cancer With or Without Adjuvant External Beam Radiation Therapy: A Population-Based Study

摘要

Background: Patients undergoing sublobar resection for early-stage non-small cell lung cancer nmay receive adjuvant radiation therapy in an effort to improve outcomes despite limited data nregarding its effi cacy. n Methods: Using the Surveillance, Epidemiology, and End-Results (SEER) registry we identifi ed npatients diagnosed with stage I non-small cell lung cancer between 1988 and 2003 who were ndefi nitively treated with sublobar surgical resection with or without adjuvant external beam nradiation therapy. Kaplan-Meier, Cox regression, and propensity-score-matched survival analyses nwere performed to evaluate the effect of adjuvant external beam radiation therapy on survival. n Results: A total of 5,908 eligible cases were identifi ed: 493 received external beam radiation ntherapy and 5,415 received no additional local-regional treatment. The use of external beam nradiation therapy was associated with signifi cantly worse median overall and disease-specifi c sur-nvival compared with no additional local-regional therapy: 31 and 45 months vs 51 and 98 months, nrespectively ( P , .001). On multivariate analysis, the most signifi cant predictor of death was the nuse of adjuvant radiation therapy (hazard ratio 1.505; 95% CI, 1.318-1.717; P , .001). The survival ndetriment associated with external beam radiation therapy remained after propensity-score-nmatched analysis. n Conclusions: The use of adjuvant external beam radiation therapy is associated with a signifi cant ndecrease in overall and disease-specifi c survival for patients with T1-2N0M0 non-small cell lung ncancer treated with sublobar resection. Although this fi nding may be related to covariables not nreported in SEER, such as margin status, chemotherapy use, radiation dose, and portal, alternative nradiation treatment strategies should be explored. CHEST 2010; 137(2):362–368