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Takamasa Mitsuyoshi



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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-25 - A Propensity Score Model for Appropriate Treatment Selection (Sublobar Resection vs. SBRT) In Patients With cStage I NSCLC (ID 11246)

      16:45 - 18:00  |  Author(s): Takamasa Mitsuyoshi

      • Abstract
      • Slides

      Background

      Stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) are current treatment options for patients with cStage I non-small-cell lung cancer (NSCLC) who are operable, but at high risk for lobectomy. However, optimal selection of the two treatments remains controversial. Purposes of this study are to identify pre-treatment factors affecting treatment decision and to evaluate their impact on outcomes.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed patients who underwent SBRT or SLR for cStage I NSCLC because of medical comorbidity between 2003 and 2009. Patients who were with performance status of 2 or worse, those who had no data on pre-treatment pulmonary function test, or those who had no histological confirmation of NSCLC were excluded. A propensity score (PS) model of treatment decision (0 toward SBRT, and 1 toward SLR) was generated using stepwise logistic regression incorporating pre-treatment factors.

      4c3880bb027f159e801041b1021e88e8 Result

      Ninety-two and 65 patients who underwent SBRT and SLR, respectively, were enrolled into this analysis. Median potential follow-up period was 8.6 years. The following factors remained in the PS model after stepwise selection: age, sex, Charlson comorbidity index (CCI), body mass index (BMI), forced expiratory volume in 1 second (FEV1) and tumor diameter. Old age, male, CCI of 1 or more, underweight BMI and large tumor had coefficients toward SBRT (Table).

      In a cohort with PS of 0.5 or more, overall survival was significantly better in SLR patients than in SBRT patients (79.5% and 47.5% at 5 years, respectively; P = 0.004). In a cohort with PS<0.5, whereas, overall survival was similar between SLR and SBRT (43.3% and 39.7% at 5 years, respectively; P = 0.805).

      Coefficients for propensity score
      Factors Coefficients
      (Intercept) (3.95)
      Age per 10y -0.53
      Sex female 0 (ref)
      male -0.62
      CCI 0 0 (ref)
      1 -0.41
      >=2 -0.97
      BMI underweight -0.98
      normal 0 (ref)
      overweight 0.44
      FEV1 per 1L 0.84
      Tumor diameter per 1cm -0.34

      8eea62084ca7e541d918e823422bd82e Conclusion

      The PS model would help appropriate treatment selection for high-risk operable patients. Although patients with PS of 0.5 or more benefit from SLR, SBRT provides comparable outcomes for patients with PS<0.5.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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