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- W2760608568 abstract "The comparative effectiveness of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer (esNSCLC) continues to be debated. Perioperative surgical mortality may give SBRT patients an early survival advantage. We endeavored to compare near-term mortality in a large esNSCLC population between patients undergoing surgery or SBRT in an analysis of the National Cancer Database (NCDB). NCDB was queried for patients with T1-T2a N0 M0 NSCLC diagnosed from 2004 to 2013 undergoing either SBRT or surgery. Thirty-day and 90-day post-treatment mortality was calculated by subtracting the time from diagnosis to treatment initiation from duration of follow-up and compared between SBRT and various surgical approaches. Patients were segmented into similarly sized age quartiles. Multivariate logistic regression (MVA) was performed to determine associations between odds of mortality and demographic, facility-specific, and clinical factors. Propensity-score matching (PSM) was also performed to derive a 3:1 (surgery:SBRT) matched cohort in order to compare odds of mortality between surgery and SBRT by univariate logistic regression. We identified 76,623 surgery patients, of whom 77.7% received lobectomy, and 8,216 SBRT patients, who received a median dose of 51 Gy. Surgical patients experienced increased mortality as compared to those undergoing SBRT at both 30 days (2.1% vs 0.7%) and 90 days (3.6% vs 2.9%), differences most pronounced among patients older than 75 (Table 1). On MVA, each surgical modality was associated with increased mortality versus SBRT at 30 days (odds ratio [OR] for sublobar resection 2.76, 95% CI 2.08-3.68; OR for lobectomy 3.52, 95% CI 2.70-4.60; OR for pneumonectomy 14.1, 95% CI 10.1-19.8; all P < 0.001) and at 90 days (OR for sublobar resection 1.36, 95% CI 1.16-1.61; OR for lobectomy 1.58, 95% CI 1.37-1.83; OR for pneumonectomy 5.59, 95% CI 4.46-7.01; all P < 0.001). Among a PSM cohort of 28,248 patients, surgical patients continued to experience increased mortality at both 30 days (2.5% vs 0.7%; OR 3.43, 95% CI 2.57-4.56; P < 0.001) and 90 days (4.2% vs 2.8%; OR 1.53, 95% CI 1.31-1.79; P < 0.001). We identified greater mortality in the near-term post-treatment period in a modern cohort of esNSCLC patients undergoing surgery versus SBRT. These findings may guide management of esNSCLC, particularly for older patients and those at greatest risk of perioperative morbidity, and underscore the importance of multidisciplinary evaluation.Abstract 1154; Table 1Age QuartileSublobar ResectionLobectomyPneumonectomyAll SurgerySBRT30-Day Mortality Rates (%)<620.70.85.31.00.762-681.31.47.21.50.469-751.72.410.92.40.8>752.93.913.83.70.890-Day Mortality Rates (%)<621.31.48.11.62.762-682.32.411.02.61.969-753.24.216.04.22.7>755.46.521.36.43.5 Open table in a new tab" @default.
- W2760608568 created "2017-10-06" @default.
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- W2760608568 date "2017-10-01" @default.
- W2760608568 modified "2023-10-18" @default.
- W2760608568 title "Treatment-Related Mortality Among Early-Stage NSCLC Patients Undergoing Surgery Versus SBRT" @default.
- W2760608568 doi "https://doi.org/10.1016/j.ijrobp.2017.06.584" @default.
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