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Original research
Post-treatment survival difference between lobectomy and stereotactic ablative radiotherapy in stage I non-small cell lung cancer in England
  1. Aamir Khakwani1,
  2. Susan Harden2,
  3. Paul Beckett3,
  4. David Baldwin4,
  5. Neal Navani5,
  6. Doug West6,
  7. Richard Hubbard7
  1. 1 Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
  2. 2 Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3 Department of Respiratory Medicine, Derby Hospital NHS Foundation Trust, Derby, UK
  4. 4 City Campus, Nottingham University Hospitals, Nottingham, UK
  5. 5 Lungs for Living Research Centre, University College London Hospital, London, UK
  6. 6 Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  7. 7 Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Aamir Khakwani, Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK; Aamir.Khakwani{at}


Background Approximately 15%–20% of all non-small cell lung cancer (NSCLC) cases present with stage I disease. Surgical resection traditionally offers the best chance of a cure but some patients will not have this treatment due to older age, comorbidities or personal choice. Stereotactic ablative radiotherapy (SABR) has become an established curative intent treatment option for patients who are not selected for or do not choose surgery. The aim of this study is to compare survival at 90 days, 6 months, 1 year and 2 years for patients who received either lobectomy or SABR.

Methods We used data from the 2015 National Lung Cancer Audit database and linked with Hospital Episode Statistics and the radiotherapy dataset to identify patients with NSCLC stage IA-IB and performance status (PS) 0–2 who underwent surgery or SABR treatment. We assessed the likelihood of death at 90 days, 6 months, 1 year and 2 year after diagnosis and procedure date to observe survival between two patient groups.

Results We identified 2373 patients in our cohort, 476 of whom had SABR. The median difference between date of diagnosis and date of treatment for surgery patients was 17 days while for SABR patients it was 73 days. Increasing age and worsening PS were associated with having SABR rather than surgery. Survival between the two treatment modalities was similar early on but by 1-year people who had surgery did better than those who had SABR (adjusted ORs 2.12, 95% CI 1.35 to 2.31). This difference persisted at 2 years and when the analysis was restricted to patients aged <80 years and with PS 0 or 1 and stage IA only.

Conclusion Our analysis suggests that patients who have lobectomy have a better survival compared with SABR patients; however, we found considerable delays in patients receiving SABR which may contribute to poorer long-term outcomes with this treatment option. Reducing these delays should be a key focus in development and reorganisation of services.

  • lung cancer
  • thoracic surgery
  • non-small cell lung cancer

Statistics from


  • Contributors The conception of the study was done by AK and RH. AK acquired the data from the National Cancer Registration and Analysis Services (NCRAS) and all analysis was done by AK. RH, SH, NN, DW, DB and PB were involved in the data interpretation. Majority of the paper (including the initial draft) was written by AK and RH, SH, DB, NN, DW and PB were involved in revising the paper critically. The final manuscript was approved by all the authors prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AK has conducted the statistical analysis for the National Lung Cancer Audit annual reports for the past 4 years, which were funded by Royal College of Physicians. None of the authors have received any personal earnings from any funding body for this work. RH has a grant provided by the British Lung Foundation chair of respiratory epidemiology.

  • Patient consent for publication Not required.

  • Ethics approval The data were obtained from NCRAS. The responsibility for reporting to CAG/HRA on the processing of cancer registration data without patient consent under the PIAG 03(a)/2001 approval transferred to Public Health England, which became known as NCRAS. The NLCA has Ethics and Confidentiality Committee (ECC) approval to use patient information from the National Health Services (NHS). The data were anonymised in the linked dataset by NCRAS personal prior to be given to the researcher.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data used in this study is available on formal request from National Cancer Registration and Analysis Service (NCRAS). Data requests can be made to the "PHE Office for Data release"

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