Surgery or stereotactic body radiotherapy for metachronous primary lung cancer? A propensity score matching analysis
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ORIGINAL ARTICLE
Surgery or stereotactic body radiotherapy for metachronous primary lung cancer? A propensity score matching analysis Takuro Miyazaki1 · Takuya Yamazaki2 · Shuntaro Sato3 · Tomoshi Tsuchiya1 · Keitaro Matsumoto1 · Go Hatachi1 · Ryoichiro Doi1 · Hironosuke Watanabe1 · Takaaki Nakatsukasa1 · Takeshi Nagayasu1 Received: 30 March 2020 / Accepted: 13 May 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective We compared outcomes after surgery or stereotactic body radiotherapy (SBRT) among patients with metachronous primary lung cancer (MPLC). Methods Patients with MPLC were treated with either surgery (2008–2018) or SBRT (2010–2018). We used propensity score matching (PSM) to reduce bias from various clinicopathological factors. MPLC was defined by the Martini and Melamed criteria. Results Of 77 patients, 51 underwent surgery and 26 received SBRT. Most median clinicopathological characteristics did not significantly differ between the surgery and SBRT groups (male sex: 67% vs 65%; age: 73 vs 77 years; time after first surgery: 6.2 vs 4.7 years; lobectomy as first procedure: 82% vs 85%; second tumor size: 11 vs 12 mm; clinical stage I: 96% vs 100%; CEA: 2.9 vs 3.0 ng/ml). However, the surgery group had significantly more ipsilateral second tumors (n = 71, 58%, P = 0.003), better performance status (P = 0.03), and preserved lung function (P = 0.02). Surgery, thus, tended to be selected for patients with good physical function and for the MPLC in the contralateral side. Five-year overall survival did not significantly differ between the surgery and SBRT groups, either before PSM (86.5% vs 65.8%, P = 0.24, log-rank) or after PSM (100% vs 84.4%, P = 0.73). Conclusions Surgery and SBRT for MPLC patients are safe and feasible treatments with similar outcomes. However, this finding should be verified by a random controlled trial with a larger study cohort. Keywords Metachronous lung cancer · Surgery · Stereotactic body radiotherapy
Introduction
Meeting presentation: This manuscript has been accepted as a rapid session presentation, published in “Daily News,” at the Meeting of the European Association for Cardio-Thoracic Surgery on October 3–5, 2019, Lisbon, Portugal. * Takuro Miyazaki miyataku@nagasaki‑u.ac.jp 1
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1‑7‑1 Sakamoto, Nagasaki 852‑8501, Japan
2
Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
3
Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
The number of metachronous primary lung cancer (MPLC) diagnoses has increased with the improvement of lung cancer (LC) patient survival [1], wider use of high-resolution chest computed tomography (CT) and LC screening programs [2–4] and an aging population with increased comorbidities. In 2010, the Japanese Joint Committee of Lung Cancer Registry Database found that 4.6% of diagnoses were multiple LCs during follow-up [1]. Many review artic
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