Hong-Wei Liu1, Zsolt Gabos2, Sunita Ghosh2, Barbara Roberts3, Harold Lau4, Marc Kerba4. 1. Central Alberta Cancer Centre, Red Deer, Canada; Department of Oncology, University of Alberta, Canada; Department of Oncology, University of Calgary, Canada. Electronic address: hongwei.liu@albertahealthservices.ca. 2. Cross Cancer Institute, Edmonton, Canada; Department of Oncology, University of Alberta, Canada. 3. Data Integration, Measurement & Reporting, Alberta Health Services, Canada. 4. Tom Baker Cancer Centre, Calgary, Canada; Department of Oncology, University of Calgary, Canada.
Abstract
PURPOSE: To review outcomes of patients with stage I non-small cell lung cancer (NSCLC) following the introduction of stereotactic body radiation therapy (SBRT). METHODS: SBRT cases were linked to the cancer registry database along with clinical, treatment and health service parameters for n=2146 cases of stage I NSCLC diagnosed between 2005 and 2011. The pre-diagnosis Aggregated Clinical Risk Grouping score (ACRG3) was used as a proxy for pre-treatment patient comorbidity. A Cox regression model and the concordance statistic (C-statistic) were used to examine variables predicted for overall survival (OS). RESULTS: The SBRT utilization rate increased annually with superior OS to conventional RT (median survival [MS] of 39.4 VS. 23.5months, P<0.001) despite higher ACRG3 scores. Surgical patients were younger, had lower ACRG3, achieving MS of 69.6months. Regression analysis indicated both Surgery (hazard ratio [HR]=0.23, 95% CI: 0.18-0.28) and SBRT (HR=0.33, 95% CI: 0.21-0.51) remained most strongly associated with OS. ACRG3 (HR=0.79, P<0.001) and age (HR=0.83, P=0.03) were independently associated with OS. The OS model was associated with the C-statistic at 0.86, 95% CI: 0.81-0.90. CONCLUSION: In stage I NSCLC patients treated with surgery have the best survival. SBRT demonstrates improved OS compared to conventional RT. C-statistic result demonstrates discrimination of treatment selection factors on OS.
PURPOSE: To review outcomes of patients with stage I non-small cell lung cancer (NSCLC) following the introduction of stereotactic body radiation therapy (SBRT). METHODS: SBRT cases were linked to the cancer registry database along with clinical, treatment and health service parameters for n=2146 cases of stage I NSCLC diagnosed between 2005 and 2011. The pre-diagnosis Aggregated Clinical Risk Grouping score (ACRG3) was used as a proxy for pre-treatment patient comorbidity. A Cox regression model and the concordance statistic (C-statistic) were used to examine variables predicted for overall survival (OS). RESULTS: The SBRT utilization rate increased annually with superior OS to conventional RT (median survival [MS] of 39.4 VS. 23.5months, P<0.001) despite higher ACRG3 scores. Surgical patients were younger, had lower ACRG3, achieving MS of 69.6months. Regression analysis indicated both Surgery (hazard ratio [HR]=0.23, 95% CI: 0.18-0.28) and SBRT (HR=0.33, 95% CI: 0.21-0.51) remained most strongly associated with OS. ACRG3 (HR=0.79, P<0.001) and age (HR=0.83, P=0.03) were independently associated with OS. The OS model was associated with the C-statistic at 0.86, 95% CI: 0.81-0.90. CONCLUSION: In stage I NSCLCpatients treated with surgery have the best survival. SBRT demonstrates improved OS compared to conventional RT. C-statistic result demonstrates discrimination of treatment selection factors on OS.
Authors: Shulong Li; Ning Yang; Bin Li; Zhiguo Zhou; Hongxia Hao; Michael R Folkert; Puneeth Iyengar; Kenneth Westover; Hak Choy; Robert Timmerman; Steve Jiang; Jing Wang Journal: Med Image Anal Date: 2018-09-15 Impact factor: 8.545
Authors: Jimmy J Caudell; Javier F Torres-Roca; Robert J Gillies; Heiko Enderling; Sungjune Kim; Anupam Rishi; Eduardo G Moros; Louis B Harrison Journal: Lancet Oncol Date: 2017-04-26 Impact factor: 41.316
Authors: Hong-Wei Liu; Marc Kerba; Gerald Lim; Zsolt Gabos; Ivo A Olivotto; Anil Abraham Joy; Wilson Roa; Zoann Nugent; Harold Lau Journal: Cureus Date: 2016-10-27