Stage I Non-Small Cell Lung Cancer: Improving Patient Selection for Minimally Invasive Lobectomy or Stereotactic Ablative Radiotherapy Based on Clinical Characteristics

In this nationwide retrospective cohort study, the authors evaluated outcomes of minimally invasive lobectomy (MIL) vs stereotactic ablative radiotherapy (SABR) in 2,183 patients with stage I non-small cell lung cancer (NSCLC) treated between 2014 and 2016. After propensity score weighting, overall survival differed by clinical subgroups. MIL was associated with superior overall survival in patients with prior myocardial infarction or heart failure (hazard ratio [HR] 0.51, 95 percent confidence interval [CI] 0.32–0.82), whereas no overall survival advantage was seen in patients without cardiac comorbidity. Patients with preserved lung function (forced expiratory volume in one second [FEV1] and diffusing capacity of the lungs for carbon monoxide [DLCO] ≥80 percent) benefited more from MIL (HR 0.61), while SABR favored those with impaired lung function (FEV1 and/or DLCO <80 percent; HR 1.50). No further significant interactions were observed for tumor stage or location.