서울의대 / 서영석, 김학재*
Abstract
BACKGROUND:
Although the choice between stereotactic ablative radiotherapy (SABR) and lobectomy for early-stage non-small cell lung cancer (NSCLC) has been debated for years, the two procedures have not yet been directly compared in a randomized trial. We conducted a virtual randomized phase III trial stratified by age to compare the effectiveness of lobectomy and SABR for medically operable patients with stage IA (AJCC eighth) NSCLC using the Markov model analysis.
METHODS:
A Markov model was developed to simulate a cohort of patients aged 45-85 years with stage IA NSCLC who had undergone either lobectomy or SABR and were followed up for their remaining lifetime. Each virtual patient was randomly assigned to undergo lobectomy or SABR, and 10 000 patients were allocated to each group. All estimates of the variables were obtained by a systematic review of published articles.
RESULTS:
The lobectomy group showed a better life expectancy than the SABR group, in patients under 75 years of age. However, no statistically significant difference was seen in patients 75 years or older. The predicted life expectancy was 9.43 and 8.70 years in 75-year-old patients in the lobectomy and SABR groups, respectively. However, the 95%CI for the difference in life expectancy between the two groups was - 0.06-1.50 years (P = 0.0689).
CONCLUSIONS:
The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy.
Author information
Seo YS1,2, Kim HJ2,3, Wu HG2,3, Choi SM4, Park S5.
1
Department of Radiation Oncology, ChungBuk National University Hospital, Chungcheongbuk-do, Republic of Korea.
2
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.
3
Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
4
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
5
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.