UC Irvine

Objective: Determine the clinical effectiveness of definitive treatment for non-small cell lung cancer (NSCLC) and perform a comparative effectiveness study of the different techniques, between surgical resection of lobectomy, radiation therapy (RT), and stereotactic body radiation (SBRT).

Patients and Methods: This study used data from the SEER Program, with 20,889 patients with Stage IA to IIIC. NSCLC The inclusion criteria were any patient identified from SEER from 2014 to 2016, over 18 years old.

Chi-squared tests were used to evaluate the differences in dichotomous variables between the treatment groups. Unadjusted Kaplan-Meier methods were used to estimate overall survival and cancer-specific survival, and we used log-rank tests to evaluate the differences in time-to-event outcomes. Two-sided p values were used, and significance level was set at 0.05. Adjusted Cox regression models assumed proportional hazards.

Results: A total of 13,760 NSCLC patients with clinical stage IA to IIIC treated with lobectomy were compared with 7,129 patients treated with radiotherapy. Adjusted multivariable Cox proportional hazards models found lobectomy to be associated with significantly better outcomes compared to radiotherapy for both early-stage (hazard ratio, T1N0, 0.31, P<.001) and advanced-stage (hazard ratio, T2N2, 0.43, P<.001). Additionally, patients undergoing lobectomy had improved mean cancer-specific survival for stages IA to IIIC.

Conclusion: Among NSCLC patients with clinical stage IA to IIIC in the SEER Database, surgical resection with lobectomy is associated with significantly improved outcomes compared to definitive radiation. Radiation for early stage disease (SBRT) or combined with chemotherapy for locally advanced-stage disease remains a good treatment option. However, when medical comorbidities and tumor characteristics permit, surgical resection should be pursued. For patients with unresectable disease, this study supports the consideration of chemoradiation as a tool to enable downstaging to achieve surgical resection.