Synchronous Primary Early-Stage Non-Small Cell Lung Cancer: Trends in Management and Factors Associated With Improved Survival.

BACKGROUND

Outcomes after multimodality curative-intent treatment of patients with synchronous primary early-stage I non-small cell lung cancer (SPELC) are inadequately understood.

METHODS

We performed a retrospective study using the Veterans Health Administration database of patients diagnosed with 2 stage I SPELC tumors who received treatment with either stereotactic body radiotherapy (SBRT) or surgery from 2006 to 2024. We evaluated use of SBRT and surgery as well as factors associated with overall survival (OS) and disease-free survival (DFS) by Cox proportional hazards models.

RESULTS

A total of 835 patients were included; 294 (35.2%) underwent SBRT-SBRT, 149 (17.8%) received SBRT-surgery, and 392 (47%) underwent surgery-surgery. Patients treated with SBRT had more comorbidities (P < .0001) and were older (P < .0001). Use of SBRT increased from <20% in 2008 to >60% of cases in 2024. The adjusted 5-year OS was 51.7% (SBRT-SBRT) vs 72% (SBRT-surgery) vs 66.7% (surgery-surgery; P < .0001). Multivariable analysis demonstrated that patients who underwent SBRT-SBRT had worse OS (hazard ratio, 1.71; 95% CI, 1.32-2.22), but those in the SBRT-surgery group and surgery-surgery group had similar OS. Adjusted 5-year DFS was 42.7% (SBRT-SBRT) vs 42.6% (surgery-SBRT) vs 57.26% (surgery-surgery). On multivariable analysis, DFS was inferior in the SBRT-SBRT group (hazard ratio, 1.525; 1.198-1.942; P = .0006) and SBRT-surgery group (hazard ratio, 1.530; 1.011-2.314; P = .04) than in the surgery-surgery group.

CONCLUSIONS

In veterans with stage I SPELC, there is heterogeneity in outcomes based on treatment modality among other factors. Patients who are selected for surgery for both lesions have the best DFS but similar OS to those who undergo surgery-SBRT.