A national analysis of wedge resection versus stereotactic body radiation therapy for stage IA non–small cell lung cancer Babatunde A. Yerokun, MD, Chi-Fu.

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Presentation transcript:

A national analysis of wedge resection versus stereotactic body radiation therapy for stage IA non–small cell lung cancer Babatunde A. Yerokun, MD, Chi-Fu Jeffrey Yang, MD, Brian C. Gulack, MD, Xuechan Li, MS, Michael S. Mulvihill, MD, Lin Gu, MS, Xiaofei Wang, PhD, David H. Harpole, MD, Thomas A. D'Amico, MD, Mark F. Berry, MD, Matthew G. Hartwig, MD The Journal of Thoracic and Cardiovascular Surgery Volume 154, Issue 2, Pages 675-686.e4 (August 2017) DOI: 10.1016/j.jtcvs.2017.02.065 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Overlap histogram for propensity score matching of the overall cohort. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan-Meier–adjusted survival of patients with clinical-stage IA NSCLC. Overall survival of matched groups is shown. HR, Hazard ratio; CI, confidence interval; KM Est, Kaplan-Meier estimate; REF, reference group; SBRT, stereotactic body radiotherapy. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Center-level comparison of SBRT to wedge resection. Scatter plot of centers stratified by their center ratio of SBRT/wedge. First-quartile centers predominately used wedge resection, whereas fourth-quartile centers predominately used SBRT. Centers with either all SBRT patients, all wedge resection patients, or with less than 5 patients were excluded. Quartiles were compared using a ratio of observed mortality to expected mortality with an O/E ≤ 1 indicating similar or better performance than expected and an O/E > 1 indicating worse performance than expected. Depicted is center 3-year mortality O/E ratios. O/E, Observed to expected; %SBRT, percent stereotactic body radiotherapy use. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) diagram. NSCLC, Non–small cell lung cancer; SBRT, stereotactic body radiotherapy; BED, biologically effective dose. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Age > 80 years subgroup analysis. Kaplan-Meier–adjusted survival of patients with clinical-stage IA NSCLC. Overall survival of matched groups is shown. HR, Hazard ratio; CI, confidence interval; KM Est, Kaplan-Meier estimate; REF, reference group; NE, nonestimable; SBRT, stereotactic body radiotherapy. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Charlson-Deyo score ≥ 2 subgroup analysis. Kaplan-Meier–adjusted survival of patients with clinical-stage IA NSCLC. Overall survival of matched groups is shown. HR, Hazard ratio; CI, confidence interval; KM Est, Kaplan-Meier estimate; REF, reference group; SBRT, stereotactic body radiotherapy. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Center-level comparison of SBRT with wedge resection. Scatterplot is shown of centers stratified by their center ratio of SBRT/wedge. First-quartile centers predominately used wedge resection, whereas fourth-quartile centers predominately used SBRT. Centers with either all SBRT patients, all wedge resection patients, or with less than 5 patients were excluded. Quartiles were compared with a ratio of observed mortality to expected mortality, with an O/E ≤ 1 indicating similar or better performance than expected and an O/E > 1 indicating worse performance than expected. Depicted is center 1-month mortality O/E ratios. O/E, Observed to expected; %SBRT, percent stereotactic body radiotherapy use. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Center-level comparison of SBRT with wedge resection. Scatter plot is shown of centers stratified by their center ratio of SBRT/wedge. First-quartile centers predominately used wedge resection, whereas fourth-quartile centers predominately used SBRT. Centers with either all SBRT patients, all wedge resection patients, or with less than 5 patients were excluded. Quartiles were compared with a ratio of observed mortality to expected mortality with an O/E ≤ 1 indicating similar or better performance than expected and an O/E > 1 indicating worse performance than expected. Depicted is center 1-year mortality O/E ratios. O/E, Observed to expected; %SBRT, percent stereotactic body radiotherapy use. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E6 Center-level comparison of SBRT with wedge resection. Scatter plot is shown of centers stratified by their center ratio of SBRT/wedge. First-quartile centers predominately used wedge resection, whereas fourth-quartile centers predominately used SBRT. Centers with either all SBRT patients, all wedge resection patients, or with less than 5 patients were excluded. Quartiles were compared with a ratio of observed mortality to expected mortality with an O/E ≤ 1 indicating similar or better performance than expected and an O/E > 1 indicating worse performance than expected. Depicted is center 2-year mortality O/E ratios. O/E, Observed to expected; %SBRT, percent stereotactic body radiotherapy use. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Overall survival for operable patients with clinical-stage IA non–small cell lung cancer. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Oral presentation of the paper from the AATS 2016 Annual Meeting. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)30639-6/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686 The Journal of Thoracic and Cardiovascular Surgery 2017 154, 675-686.e4DOI: (10.1016/j.jtcvs.2017.02.065) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions