Patients With Surgically Resectable Lung Cancer Who Opt for Radiation Have Worse Outcomes

K. J.. Song¹, I. Faith², E. Taioli³, K. Rosenzweig³, R. Flores^3
1Mount Sinai Hospital, New York, New York ²Albert Einstein College of Medicine, New York, New York ³Mount Sinai Health System, New York, New York

Purpose: Surgery has long been the standard of care for resectable primary lung cancer. Survival after stereotactic body radiation (SBRT), another treatment option, is significantly biased due to the majority of data resulting from patients deemed unsuitable for surgery. We examined survival of patients refusing surgery in favor of radiation therapy.

Methods: The November 2018 Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with primary stage I non-small cell lung cancer (NSCLC) diagnosed between 2007-2016. Staging was determined using the American Joint Committee on Cancer system available at the time of treatment. Patients were excluded if it was unknown if they were recommended for surgery, if surgery was contraindicated, or if age at diagnosis was < 18 years. Patients whose radiation status was unknown were considered to not have received radiotherapy.
Multiple predictors were assessed including age at diagnosis, sex, race/ethnicity, health insurance status, residence near an urban area, marital status, histology, and receipt of radiotherapy. A multivariate analysis was performed to estimate hazard ratios and generate Kaplan-Meier survival curves.

Results: When adjusted for confounding variables including age, sex, race, and size of tumor, survival was greater for patients undergoing surgical resection than those refusing surgery in favor of radiation (HRadj 2.66; 95% CI: 2.27-3.11, p< 0.001) (Figure 1), or for those receiving no standardized treatment (HRadj 4.43; 95% CI: 3.57-5.50, p< 0.001). Among patients undergoing surgical resection, survival was decreased with older age (HRadj 1.8; 95% CI: 1.69-2.01, p< 0.001) and in males (HRadj 1.51; 95% CI: 1.43-1.59, p< 0.001).

Conclusion: SBRT is known to be a safe and effective treatment for inoperable early lung cancer but there is limited data comparing outcomes against surgical resection, as several comparative prospective randomized trials have closed due to poor accrual. The findings of our study suggest that when eligible for both, those patients choosing radiation over surgery had worse overall survival, and these results are maintained when adjusting for several variables including age and tumor size. This may suggest that surgical resection is a superior treatment modality for resectable primary non-small cell lung cancer.

Identify the source of the funding for this research project: None