Sublobar resection compared with stereotactic body radiation therapy and ablation for early stage non–small cell lung cancer: A National Cancer Database study

Objectives: To compare the overall survival (OS) outcomes of sublobar resection (SLR) with stereotactic body radiation therapy (SBRT) or ablation for patients with early stage non–small cell lung cancer (NSCLC). Methods: Patients with clinical stage I (T1-T2aN0M0) NSCLC from 2004 to 2014 who were treated with SLR, SBRT, or ablation as the sole treatment were identified from the National Cancer Database. OS was estimated using the Kaplan–Meier method and evaluated by log-rank test, univariate and multivariate Cox proportional hazard regression, and propensity score–matched analysis. Relative survival analyses compared with age- and sex-matched US population were performed. Results: A total of 53,973 patients were identified. The 1-, 2-, 3-, and 5-year relative survival rates were 96%, 90%, 84%, and 71% for SLR (n = 30,451); 93%, 78%, 65%, and 46% for SBRT (n = 22,134); and 90%, 73%, 58%, and 37% for ablation (n = 1388). Propensity score matching resulted in 9967 patients in the SBRT group versus 9967 in the SLR group and 1062 patients in the ablation group versus 1984 in the SLR group. After matching, both SBRT (hazard ratio, 1.559; 95% confidence interval, 1.497-1.623; P <.001) and ablation (hazard ratio, 1.906; 95% confidence interval, 1.730-2.101; P <.001) were associated with shorter OS when compared with SLR. These results persisted in patients with tumor size ≤2 cm. Conclusions: Preliminary results suggest SLR may be associated with longer OS in patients with early-stage NSCLC compared with SBRT or ablation. Future prospective, randomized, controlled clinical trials comparing these treatments are needed to confirm these results.