Nodal staging before SBRT does not affect survival in early-stage NSCLC

Patients with early-stage nonsmall cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT) have similar overall survival (OS) regardless of nodal staging, reports a study. In addition, use of SBRT has shown a steady increase over the study period.

Of note, majority of the patients “proceeded SBRT without nodal staging, conflicting with National Comprehensive Cancer Network (NCCN) guidelines, which recommend pathologic mediastinal lymph node evaluation for all early-stage NSCLC cases, except stage IA,” the authors said.

Of the 12,106 patients included, 865 (7 percent) received invasive staging (nodal sampling, NS) and 11,241 (93 percent) had no NS. Propensity score matching (1:1 without replacement) yielded 839 patients for each group (NS and no NS).

Median survival for these patients was 2.75 years (95 percent confidence interval [CI], 2.55‒2.93) over a median follow-up of 3.12 years, with 2- and 5-year OS estimated at 63.9 percent and 25.7 percent, respectively.

Multivariable analysis revealed no significant difference in mortality risk between the NS and no NS groups (hazard ratio, 1.08, 95 percent CI, 0.94‒1.24; p=0.25). In addition, the following factors were significantly associated with a negative prognosis: age >65 years, male sex, Charlson-Deyo Score ≥1, and tumour size ≥3 cm.

For this study, the authors identified early-stage NSCLC patients with definitive SBRT in the National Cancer Database. They determined the OS based on method of staging and analysed patient, disease, and treatment characteristics.