TY - JOUR
T1 - Stage I non-small cell lung cancer
T2 - improving patient selection for minimally invasive lobectomy or stereotactic ablative radiotherapy based on clinical characteristics
AU - de Ruiter, Julianne Cynthia
AU - van der Noort, Vincent
AU - van Diessen, Judi Nani Annet
AU - Smit, Egbert Frederik
AU - Damhuis, Ronald Alphons Maria
AU - Hartemink, Koen Johan
AU - Yang, Z. L.
AU - van der Woude, L.
AU - van den Wildenberg, F. J.H.
AU - Wijsman, R.
AU - Wener, R. R.
AU - van der Wekken, A. J.
AU - de Wee, E. M.
AU - van de Wauwer, C.
AU - van der Voort van Zyp, N. C.M.G.
AU - Verhoeff, J. J.C.
AU - Verhagen, A. F.T.M.
AU - Verbruggen, L.
AU - Verbogt, N. P.A.
AU - van Velthoven-Hoogers, A.
AU - Veenhof, A. A.F.A.
AU - Veen, E. J.
AU - Thönissen, N. M.
AU - van Thiel, E.
AU - Susa, D.
AU - Steward, A. J.
AU - Stellingwerf, M.
AU - Speekenbrink, R. G.H.
AU - Spaans, L. N.
AU - Smit, W. G.J.M.
AU - Smit, E. F.
AU - Smakman, N.
AU - Schweitzer, D.
AU - Schiefer, M.
AU - de Ruysscher, D. K.
AU - de Ruiter, J. C.
AU - Rikers, C.
AU - Rijna, H.
AU - van Putten, S. E.
AU - van Putten, J. W.G.
AU - Paulus, G. F.
AU - Palamba, H. W.
AU - Overhof-Wedick, C.
AU - Osté, E.
AU - Oosthoek, L. W.J.
AU - Oosterhuis, J. W.A.
AU - Nuyttens, J. J.M.E.
AU - van Middendorp, L. B.
AU - Maessen, J. G.
AU - Hendriks, L. E.L.
AU - ESLUNG group
N1 - Funding Information:
EFS reports grants from AstraZeneca and Daiichi Sankyo, consulting fees from AstraZeneca, BMS, Boehringer Ingelheim, Daiichi Sankyo, Sanofi, Eli Lilly, Roche Genentech, Merck, Novartis, Pfizer, Takeda and Taiho and honoraria from Boehringer Ingelheim. The other authors declare no competing interests.
Funding Information:
This work was supported by KWF Dutch Cancer Society [grant number 12928].
Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature Limited 2025.
PY - 2026/3/20
Y1 - 2026/3/20
N2 - Background: We aimed to identify patient and tumour characteristics associated with differential benefit from minimally invasive lobectomy (MIL) or stereotactic ablative radiotherapy (SABR) for stage I non-small cell lung cancer (NSCLC). Methods: Patients with clinical stage I NSCLC (TNM7), treated with MIL or SABR in 2014-2016, were included in this retrospective cohort study. Propensity score (PS) weighting was used to create a virtual SABR cohort with characteristics comparable to the MIL group. We assessed interactions between treatment type and clinical characteristics affecting overall survival (OS) and recurrence-free survival (RFS). Results: 1211 MIL and 972 SABR patients were included. After PS weighting, the impact of treatment type on OS differed significantly between patients with prior myocardial infarction or heart failure (HR 0.51, 95% CI 0.32-0.82; favouring MIL) versus patients without (HR 1.09, 95% CI 0.70-1.67) (p = 0.02). Moreover, MIL yielded superior OS in patients with both FEV
1 and DLCO ≥ 80% (HR 0.61, 95% CI 0.30-1.26), while SABR favoured patients with FEV
1 and/or DLCO < 80% (HR 1.50, 95% CI 0.95-2.36) (p = 0.04). Conclusions: Interactions of treatment type with lung function and with prior myocardial infarction or heart failure impacted OS for patients with stage I NSCLC. These findings warrant validation in other studies to further refine treatment decision-making.
AB - Background: We aimed to identify patient and tumour characteristics associated with differential benefit from minimally invasive lobectomy (MIL) or stereotactic ablative radiotherapy (SABR) for stage I non-small cell lung cancer (NSCLC). Methods: Patients with clinical stage I NSCLC (TNM7), treated with MIL or SABR in 2014-2016, were included in this retrospective cohort study. Propensity score (PS) weighting was used to create a virtual SABR cohort with characteristics comparable to the MIL group. We assessed interactions between treatment type and clinical characteristics affecting overall survival (OS) and recurrence-free survival (RFS). Results: 1211 MIL and 972 SABR patients were included. After PS weighting, the impact of treatment type on OS differed significantly between patients with prior myocardial infarction or heart failure (HR 0.51, 95% CI 0.32-0.82; favouring MIL) versus patients without (HR 1.09, 95% CI 0.70-1.67) (p = 0.02). Moreover, MIL yielded superior OS in patients with both FEV
1 and DLCO ≥ 80% (HR 0.61, 95% CI 0.30-1.26), while SABR favoured patients with FEV
1 and/or DLCO < 80% (HR 1.50, 95% CI 0.95-2.36) (p = 0.04). Conclusions: Interactions of treatment type with lung function and with prior myocardial infarction or heart failure impacted OS for patients with stage I NSCLC. These findings warrant validation in other studies to further refine treatment decision-making.
U2 - 10.1038/s41416-025-03332-7
DO - 10.1038/s41416-025-03332-7
M3 - Article
SN - 0007-0920
VL - 134
SP - 893
EP - 902
JO - British Journal of Cancer
JF - British Journal of Cancer
IS - 6
ER -