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Abstract：
BACKGROUND: This study compared the survival outcomes after thermal ablation versus wedge resection in patients with stage I non-small cell lung cancer (NSCLC) ≤ 2 cm.
METHODS: Data from the United States (US) National Cancer Institute Surveillance Epidemiology and End Results (SEER) database from 2004 to 2019 were retrospectively analyzed. Patients with stage I NSCLC and lesions ≤ 2 cm who received thermal ablation or wedge resection were included. Patients who received chemotherapy or radiotherapy were excluded. Propensity-score matching (PSM) was applied to balance the baseline characteristics between patients who underwent the two procedures.
RESULTS: Univariate and Cox regression analyses were performed to determine the associations between study variables, overall survival (OS), and cancer-specific survival (CSS). After PSM, 328 patients remained for analysis. Multivariable Cox regression analysis revealed, compared to wedge resection, thermal ablation was significantly associated with a greater risk of poor OS (adjusted HR [aHR]: 1.34, 95% CI: 1.09-1.63, p = 0.004) but not CSS (aHR: 1.28, 95% CI: 0.96-1.71, p = 0.094). In stratified analyses, no significant differences were observed with respect to OS and CSS between the two procedures regardless of histology and grade. In patients with tumor size 1 to 2 cm, compared to wedge resection, thermal ablation was significantly associated with a higher risk of poor OS (aHR: 1.35, 95% CI: 1.10-1.66, p = 0.004). In contrast, no significant difference was found on OS and CSS between thermal ablation and wedge resection among those with tumor size < 1 cm.
CONCLUSIONS: In patients with stage I NSCLC and tumor size < 1 cm, thermal ablation has similar OS and CSS with wedge resection.
METHODS: Data from the United States (US) National Cancer Institute Surveillance Epidemiology and End Results (SEER) database from 2004 to 2019 were retrospectively analyzed. Patients with stage I NSCLC and lesions ≤ 2 cm who received thermal ablation or wedge resection were included. Patients who received chemotherapy or radiotherapy were excluded. Propensity-score matching (PSM) was applied to balance the baseline characteristics between patients who underwent the two procedures.
RESULTS: Univariate and Cox regression analyses were performed to determine the associations between study variables, overall survival (OS), and cancer-specific survival (CSS). After PSM, 328 patients remained for analysis. Multivariable Cox regression analysis revealed, compared to wedge resection, thermal ablation was significantly associated with a greater risk of poor OS (adjusted HR [aHR]: 1.34, 95% CI: 1.09-1.63, p = 0.004) but not CSS (aHR: 1.28, 95% CI: 0.96-1.71, p = 0.094). In stratified analyses, no significant differences were observed with respect to OS and CSS between the two procedures regardless of histology and grade. In patients with tumor size 1 to 2 cm, compared to wedge resection, thermal ablation was significantly associated with a higher risk of poor OS (aHR: 1.35, 95% CI: 1.10-1.66, p = 0.004). In contrast, no significant difference was found on OS and CSS between thermal ablation and wedge resection among those with tumor size < 1 cm.
CONCLUSIONS: In patients with stage I NSCLC and tumor size < 1 cm, thermal ablation has similar OS and CSS with wedge resection.
摘要：
背景：本研究比较了I期非小细胞肺癌（NSCLC）≤2cm患者热消融与楔形切除术后的生存结果。
方法：对2004年至2019年美国国家癌症研究所监测流行病学和最终结果（SEER）数据库中的数据进行回顾性分析。包括接受热消融或楔形切除术的I期NSCLC和病变≤2cm的患者。接受化疗或放疗的患者被排除在外。使用倾向评分匹配（PSM）来平衡接受两种手术的患者之间的基线特征。
结果：进行单变量和Cox回归分析以确定研究变量之间的关联，总生存期（OS），癌症特异性生存率（CSS）。PSM之后,328名患者仍有待分析。多变量Cox回归分析显示，与楔形切除术相比，热消融与不良OS的风险显著相关(校正后HR[aHR]:1.34,95%CI:1.09-1.63,p=0.004),但与CSS无关(aHR:1.28,95%CI:0.96-1.71,p=0.094).在分层分析中，无论组织学和分级如何,两种手术在OS和CSS方面均未观察到显著差异.在肿瘤大小为1至2厘米的患者中，与楔形切除术相比，热消融与OS不良的高风险显著相关(aHR:1.35,95%CI:1.10-1.66,p=0.004).相比之下,在肿瘤大小<1cm的患者中，热消融和楔形切除术在OS和CSS上没有发现显着差异。
结论：在I期非小细胞肺癌且肿瘤大小<1cm的患者中，热消融具有与楔形切除相似的OS和CSS。
方法：对2004年至2019年美国国家癌症研究所监测流行病学和最终结果（SEER）数据库中的数据进行回顾性分析。包括接受热消融或楔形切除术的I期NSCLC和病变≤2cm的患者。接受化疗或放疗的患者被排除在外。使用倾向评分匹配（PSM）来平衡接受两种手术的患者之间的基线特征。
结果：进行单变量和Cox回归分析以确定研究变量之间的关联，总生存期（OS），癌症特异性生存率（CSS）。PSM之后,328名患者仍有待分析。多变量Cox回归分析显示，与楔形切除术相比，热消融与不良OS的风险显著相关(校正后HR[aHR]:1.34,95%CI:1.09-1.63,p=0.004),但与CSS无关(aHR:1.28,95%CI:0.96-1.71,p=0.094).在分层分析中，无论组织学和分级如何,两种手术在OS和CSS方面均未观察到显著差异.在肿瘤大小为1至2厘米的患者中，与楔形切除术相比，热消融与OS不良的高风险显著相关(aHR:1.35,95%CI:1.10-1.66,p=0.004).相比之下,在肿瘤大小<1cm的患者中，热消融和楔形切除术在OS和CSS上没有发现显着差异。
结论：在I期非小细胞肺癌且肿瘤大小<1cm的患者中，热消融具有与楔形切除相似的OS和CSS。
