Abstract
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 FEV1 and DLCO ≥ 80% (HR 0.61, 95% CI 0.30-1.26), while SABR favoured patients with FEV1 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.
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Data availability
Deidentified data are available upon reasonable request from the corresponding author, depending on institutional review and national privacy regulations.
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Funding
This work was supported by KWF Dutch Cancer Society [grant number 12928].
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Julianne de Ruiter: Conceptualisation, Data Curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Project administration, Writing—Original Draft, Writing—Review and Editing. Vincent van der Noort: Data Curation, Formal Analysis, Investigation, Methodology, Software, Visualisation, Writing - Original Draft, Writing —Review and Editing. Judi van Diessen: Investigation, Methodology, Writing - Review and Editing. Egbert Smit: Investigation, Writing—Review and Editing. Ronald Damhuis: Investigation, Writing—Review and Editing. Koen Hartemink: Conceptualisation, Funding acquisition, Investigation, Methodology, Supervision, Writing - Original Draft, Writing - Review and Editing. ESLUNG group: Investigation, Writing—Review and Editing.
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Competing interests
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.
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All methods were performed in accordance with the relevant guidelines and regulations. This study was approved by the Institutional Review Boards of the participating centres. Data were collected anonymously and informed consent was waived because of the retrospective nature of the study.
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de Ruiter, J.C., van der Noort, V., van Diessen, J.N.A. et al. Stage I non-small cell lung cancer: improving patient selection for minimally invasive lobectomy or stereotactic ablative radiotherapy based on clinical characteristics. Br J Cancer (2026). https://doi.org/10.1038/s41416-025-03332-7
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DOI: https://doi.org/10.1038/s41416-025-03332-7
