Background:With rising life expectancy and widespread lung cancer screening, early-stage non-small cell lung cancer (NSCLC) incidence has increased. While surgery is the standard treatment for operable stage I NSCLC, many patients are ineligible due to age or comorbidities. Stereotactic body radiotherapy (SBRT) has achieved good primary tumor control rates and overall survival. This study compares the outcomes of SBRT and surgery for stage I NSCLC using propensity score overlap-weighted dataset.Methods:This retrospective study analyzed clinical stage I NSCLC patients treated at a tertiary hospital from 2012 to 2021. Baseline differences between SBRT and surgery groups were adjusted using overlap weighting. AI-based CT analysis (CT AI-CAD) assessed tumor characteristics, verified by radiologists. Primary outcomes were 5-year cumulative incidence of recurrence and overall survival, with subgroup analyses based on tumor features.Results:Of 1474 patients, 1258 underwent surgery, and 216 received SBRT. After overlap weighting, baseline characteristics were well balanced. The 5-year cumulative incidence of recurrence and OS showed no statistically significant differences between SBRT and surgery groups (recurrence: 16.2% vs. 16.1%; OS: 80.5% vs. 82.9%). Further AI-based CT subgroup analysis showed no significant differences in recurrence rates across tumor features. A solid tumor diameter associated with a significant increase in recurrence was identified as 16.6 mm for SBRT and 18.6 mm for surgery.Conclusions:After overlap weighting, SBRT and surgery showed no statistically significant differences in treatment outcomes in stage I NSCLC. These findings may help guide the timing and selection of safe and effective treatment approaches.
背景：随着预期寿命延长和肺癌筛查的普及，早期非小细胞肺癌（NSCLC）发病率呈上升趋势。虽然手术是可手术I期NSCLC的标准治疗方案，但许多患者因年龄或合并症不符合手术条件。立体定向体部放疗（SBRT）已展现出良好的原发肿瘤控制率和总生存率。本研究采用倾向评分重叠加权数据集，比较SBRT与手术治疗I期NSCLC的临床结局。 方法：本回顾性研究分析了2012年至2021年在某三级医院接受治疗的临床I期NSCLC患者。采用重叠加权法调整SBRT组与手术组的基线差异。基于人工智能的CT分析系统（CT AI-CAD）评估肿瘤特征，并由放射科医师复核验证。主要结局指标为5年累积复发率和总生存率，并根据肿瘤特征进行亚组分析。 结果：在1474例患者中，1258例接受手术治疗，216例接受SBRT治疗。经重叠加权后，两组基线特征达到良好平衡。SBRT组与手术组的5年累积复发率和总生存率均无统计学显著差异（复发率：16.2% vs. 16.1%；总生存率：80.5% vs. 82.9%）。进一步的AI-CT亚组分析显示，不同肿瘤特征的复发率均无显著差异。研究发现与复发风险显著相关的实体瘤直径临界值：SBRT组为16.6毫米，手术组为18.6毫米。 结论：经重叠加权调整后，SBRT与手术治疗I期NSCLC的临床结局无统计学显著差异。这些发现可能为安全有效治疗方案的时机选择和决策制定提供参考依据。
肿瘤(癌症)患者之家