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Mortality after radiotherapy or surgery in the treatment of early stage non-small-cell lung cancer: a population-based study on recent developments

  • Original Article – Clinical Oncology
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Abstract

Background

Stereotactic body radiotherapy (SBRT) can achieve high tumour control with limited toxicity for inoperable early stage non-small-cell lung cancer (NSCLC) patients.

Patients and methods

The German Epidemiologic Cancer Registries from the Robert-Koch Institute were assessed. Periods according to the availability of SBRT were: (1) 2000–2003 (pre-SBRT); (2) 2004–2007 (interim); and (3) 2007–2014 (broad availability of SBRT). To assess the association of cancer-related parameters with mortality, hazard ratios (HR) from Cox proportional hazards models were computed. To evaluate the change of treatment-related mortality, we performed interaction analyses and the relative excess risk due to interaction (RERI, additive scale) was computed.

Results

A total of 16,292 patients with UICC stage I NSCLC diagnosed between 2000 and 2014 were analysed. Radiotherapy utilization increased from 5% in pre-SBRT era to 8.8% after 2007. In univariate analyses, survival in the whole cohort improved only marginally when 2000–2003 is compared to 2004–2007 (HR 0.92, 95% CI 0.85–1.01) or 2008–2014 (HR 0.93, 95% CI 0.86–1.01). Comparing surgery/radiotherapy, mortality in the radiotherapy group started from a 3.5-fold risk in 2000–2003 to 2.6 after 2007. The interaction analysis revealed a stronger improvement for radiotherapy (multiplicative scale for 2000–2003 vs. > 2007: 0.74, 95% CI 0.58–0.94). On an additive scale, treatment × period interaction revealed an RERI for 2000–2003 vs. > 2007 of − 1.18 (95% CI − 1.8, − 0.55).

Conclusions

Using population-based data, we observed a survival improvement in stage I lung cancer over time. With an increasing utilization of radiotherapy, a stronger improvement occurred in patients treated with radiotherapy when compared to surgery.

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Abbreviations

UICC:

Unité international contre le cancer

NSCLC:

Non-small-cell lung cancer

VATS:

Video-assisted thoracoscopic surgery

SBRT:

Stereotactic body radiotherapy

OS:

Overall survival

RT:

Radiotherapy

RKI:

Robert-Koch Institute

HR:

Hazard ratio

Ci:

Confidence interval

SCLC:

Small-cell lung cancer

ECOG:

Eastern Co-operative Oncology Group

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Acknowledgements

We would like to thank the Robert Koch Institute (RKI), especially Dr. Klaus Kraywinkel, and the Epidemiologic Cancer Register in Germany for kindly providing the raw data for analysis.

Funding

No grant number is applicable.

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Authors and Affiliations

  1. Department of Radiation Oncology, Martin Luther University, Halle, Germany

    C. Ostheimer, C. Evers, F. Palm, D. Vordermark & Daniel Medenwald

  2. Institute of Medical Epidemiology, Biometry and Informatics, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 24, 06114, Halle (Saale), Germany

    F. Palm, R. Mikolajczyk & Daniel Medenwald

Authors
  1. C. Ostheimer
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  2. C. Evers
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  3. F. Palm
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  4. R. Mikolajczyk
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  5. D. Vordermark
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  6. Daniel Medenwald
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Corresponding author

Correspondence to Daniel Medenwald.

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Figure S1:

Flow chart of the cohort and the final number of patients taken into account. (TIFF 364 kb)

Supplementary material 2 (DOC 23 kb)

Table S1:

Detailed survival characteristics (characteristics by treatment and period). (DOC 34 kb)

Table S2:

Results of the treatment-specific multivariate analyses of overall mortality. Effect estimates refer to hazard ratios with 95% confidence intervals from Cox-regression models. HR = hazard ratio, CI = 95% confidence interval (DOCX 13 kb)

Table S3:

Multivariate Interaction analyses comparing surgery and radiotherapy in relation to overall mortality considering only registries with higher data quality (Hager et al. 2015). Effect estimates refer to hazard ratios with 95% confidence intervals from Cox-regression models. Interaction analyses were performed on a multiplicative and additive scale. HR = hazard ratio, CI = 95% confidence interval, RERI = risk excess due to interaction (DOC 45 kb)

Table S4:

Multivariate Interaction analyses comparing surgery and radiotherapy in relation to overall mortality considering only cases with an age of 75 years or older. Effect estimates refer to hazard ratios with 95% confidence intervals from Cox-regression models. Interaction analyses were performed on a multiplicative and additive scale. HR = hazard ratio, CI = 95% confidence interval, RERI = risk excess due to interaction (DOC 45 kb)

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Ostheimer, C., Evers, C., Palm, F. et al. Mortality after radiotherapy or surgery in the treatment of early stage non-small-cell lung cancer: a population-based study on recent developments. J Cancer Res Clin Oncol 145, 2813–2822 (2019). https://doi.org/10.1007/s00432-019-03013-y

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  • DOI: https://doi.org/10.1007/s00432-019-03013-y

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