Introduction: There is an ongoing debate on the optimal treatment for stage I NSCLC, with increasing evidence for comparable health outcomes after surgery and stereotactic body radiation therapy (SBRT). For clinical decision making, the experienced quality of life, summarized as health utility, is of importance to choosing between treatments. In this study, we evaluated differences in longitudinal health utility in stage I NSCLC in the first year after surgical resection versus after SBRT before any recurrence of disease. We also assessed the impact of potential prognostic variables on health utility. Methods: Prospectively collected databases containing data on patients with stage I NSCLC treated with either SBRT or surgery were pooled from two large hospitals in the Netherlands. Quality of life data were measured by the Quality of Life Questionnaire–Core 30 questionnaire at baseline and 3, 6, and 12 months after treatment. Health utility (measured using the European Quality of Life Five‐Dimension questionnaire) was calculated from the Quality of Life Questionnaire–Core 30 questionnaire by using a mapping algorithm. Propensity score matching was used to adjust for selection bias. Treatment effects were estimated for the matched patients by using a longitudinal mixed model approach. Results: After correction for Eastern Cooperative Oncology Group score, sex, and age, the difference in 1‐year averaged health utility between the SBRT and surgery groups was 0.026 (95% confidence interval: 0.028–0.080). Differences in health utility decreased over time. Conclusions: A small but not statistically significant difference in health utility was found between patients with stage I NSCLC treated with surgery and those treated with SBRT. Current analysis strengthens existing evidence that SBRT is an equivalent treatment option for early‐stage NSCLC. Comparative cost‐effectiveness remains to be determined.

中文翻译：

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I期非小细胞肺癌立体定向放射治疗和手术在纵向健康效用上的差异

简介：关于 I 期 NSCLC 的最佳治疗方法一直存在争论，越来越多的证据表明手术和立体定向放射治疗 (SBRT) 后的健康结果具有可比性。对于临床决策，体验的生活质量，概括为健康效用，对于选择治疗方法很重要。在这项研究中，我们评估了手术切除后第一年 I 期 NSCLC 与任何疾病复发前 SBRT 后纵向健康效用的差异。我们还评估了潜在预后变量对健康效用的影响。方法：前瞻性收集的数据库包含来自荷兰两家大型医院的接受 SBRT 或手术治疗的 I 期 NSCLC 患者的数据。生活质量数据通过生活质量问卷 - 核心 30 问卷在基线和治疗后 3、6 和 12 个月进行测量。健康效用（使用欧洲生活质量五维问卷测量）是通过使用映射算法从生活质量问卷 - 核心 30 问卷中计算出来的。倾向得分匹配用于调整选择偏差。通过使用纵向混合模型方法估计匹配患者的治疗效果。结果：校正东部肿瘤协作组评分、性别和年龄后，SBRT 组和手术组之间 1 年平均健康效用的差异为 0.026（95% 置信区间：0.028-0.080）。健康效用的差异随着时间的推移而减少。结论：在接受手术治疗的 I 期 NSCLC 患者和接受 SBRT 治疗的患者之间发现了健康效用的微小但非统计学显着差异。目前的分析加强了现有证据，即 SBRT 是早期 NSCLC 的等效治疗选择。比较成本效益仍有待确定。