Trends and Outcomes of Salvage Lobectomy for Early-stage Non–Small Cell Lung Cancer

Abstract

Objectives: There is little data describing the outcomes for patients who develop local recurrences after stereotactic body radiation therapy (SBRT), a standard-of-care treatment for patients with early-stage non–small cell lung cancer. One emerging option is salvage lobectomy. We investigated trends in the use of salvage lobectomy after SBRT and described patient outcomes using a nationally representative sample. Methods: This is a retrospective study using the National Cancer Database of patients with non–small cell lung cancer diagnosed from 2004 to 2017. We used descriptive statistics to describe patients who underwent salvage lobectomy. Kaplan-Meier analysis was used to estimate overall survival (OS). Cox proportional modeling was used to identify factors associated with OS. Results: We identified 276 patients who underwent salvage lobectomy. Ninety-day mortality was 0%. The median survival time for the cohort was 50 months (95% CI, 44 to 58). Median follow-up was 65 months (Interquartile Range: 39 to 96). The factors associated with decreased OS include squamous cell histology (hazard ratio (HR)=1.72, P=0.005) and high grade (1.50, P=0.038). Increased OS was associated with lobectomy performed between 3 and 6 months after SBRT (HR=0.53, P=0.021), lobectomy performed >6 months after SBRT (HR=0.59, P=0.015), and female sex (HR=0.56, P=0.004). Conclusions: Salvage lobectomy after local failures of SBRT was associated with no perioperative mortality and favorable long-term outcomes. Our data suggest that lobectomy performed within 3 months of SBRT is associated with worse OS.