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Noriko Kishi



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    P05 - Early Stage/Localized Disease - Radiotherapy (ID 114)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P05.08 - A Propensity Score-Weighted Analysis for SBRT, Lobectomy and Sublobar Resection in Elderly Patients with cStage I NSCLC (ID 839)

      00:00 - 00:00  |  Presenting Author(s): Noriko Kishi

      • Abstract
      • Slides

      Introduction

      There are three treatment options for clinical Stage I non-small cell lung cancer (NSCLC) patients: lobectomy, stereotactic body radiotherapy (SBRT) and sublobar resection (SLR). For “high-risk operable” patients, decision making about their treatment is an issue as well as for physicians. The aim of this study was to compare survival outcomes among the three treatments aiming for optimal treatment selection.

      Methods

      Consecutive cStage I NSCLC patients (aged 65 or older) treated with lobectomy, SBRT or SLR because of medical comorbidities from 2003 to 2014 at our institute were retrospectively reviewed. Patients with synchronous second primary lung cancer, Propensity scores for the three groups were estimated using a machine learning method incorporating the following covariates: age, sex, ECOG-PS, smoking status, Charlson comorbidity index, body mass index, tumor size, consolidation/tumor ratio, and forced expiratory volume in 1 second. The patient cohort was weighted using the marginal mean weighting with stratification method. Cox proportional hazard model were used to compare overall survival (OS). Subgroups were set with proper cut-off propensity scores maximizing rank statistics.

      Results

      Eight hundred twenty-three patients were enrolled into this study (lobectomy, 480; SBRT, 204; and SLR, 139). The median follow-up period was 5.4 years. The 5-year OS were 80.2% in lobectomy, 46.6% in SBRT, and 71.9% in SLR, respectively (Figure). After the propensity score weighting, all the covariates were well balanced among the three treatments. In the weighted cohort, the 5-year OS were 77.8% in lobectomy, 59.0% in SBRT and 63.9% in SLR, respectively. Lobectomy yields better survival outcome than SBRT (hazard ratio [HR] = 0.51, 95% confidence interval [CI]: 0.40-0.66, p < 0.001), while the difference in OS was not significant between SBRT and SLR (HR = 0.80, 95% CI: 0.58-1.09, p = 0.16). In a subgroup with propensity score for SBRT<0.46, lobectomy<0.72 and SLR<0.37 consisting of 93 lobectomy, 47 SBRT, and 45 SLR patients, OS was not significantly different between the three treatments (HR for lobectomy = 0.78, 95% CI: 0.47-1.31, p = 0.35, HR for SLR = 0.89, 95% CI: 0.50-1.57, p = 0.68).

      figure_wclc20200827.png

      Conclusion

      OS of SBRT was not significantly different from that of SLR, and was significantly inferior to that of lobectomy for cStage I NSCLC elderly patients in terms of average treatment effect. However, the subgroup analysis suggested that selected patients were potentially eligible for either of the three treatments.

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