Recurrence and disease-free survival outcomes after computed tomography-guided needle biopsy in stage IA non-small cell lung cancer patients in China: a propensity score matching analysis

Chuang He; Hualong Yu; Changyi Li; Xin Zhang; Zhicheng Huang; Mingyang Liu; Lunbing Tong; Jun Zhu; Wei Wu; Xuequan Huang

doi:10.21037/qims-20-931

Recurrence and disease-free survival outcomes after computed tomography-guided needle biopsy in stage IA non-small cell lung cancer patients in China: a propensity score matching analysis

Quant Imaging Med Surg. 2021 Aug;11(8):3472-3480. doi: 10.21037/qims-20-931.

Authors

Chuang He¹, Hualong Yu², Changyi Li³, Xin Zhang⁴, Zhicheng Huang⁵, Mingyang Liu⁶, Lunbing Tong⁷, Jun Zhu⁸, Wei Wu⁹, Xuequan Huang¹

Affiliations

¹ Treatment Center of Minimally Invasive Intervention and Radioactive Particles, First Affiliated Hospital of the Army Medical University, Chongqing, China.
² Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China.
³ Department of Respiratory, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁴ Department of Thoracic Surgery, General Hospital of Heilongjiang Province Land Reclamation Bureau, Harbin, China.
⁵ Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China.
⁶ Department of Oncology, General Hospital of Heilongjiang Province Land Reclamation Bureau, Harbin, China.
⁷ Department of Radiology, Sichuan Police Force Hospital, Leshan, China.
⁸ Department of Radiology, The Second People's Hospital of Yibin, Yibin, China.
⁹ Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Chongqing, China.

Abstract

Background: Whether preoperative biopsy before radical resection can lead to recurrence and impact patient survival in non-small cell lung cancer (NSCLC) remains controversial. In this study, we carried out a retrospective analysis to determine whether preoperative biopsy can cause disease recurrence and influence disease-free survival (DFS) in patients with stage IA NSCLC.

Methods: Patients diagnosed with stage IA NSCLC (solid nodule) between January 2010 and December 2014 were identified from the databases of 7 Chinese medical centers and divided into two groups: a preoperative computed tomography (CT)-guided needle biopsy (CTNB) plus radical resection group, and a non-CTNB group. The propensity score matching (PSM) method was adopted to balance the observed covariates, and Kaplan-Meier estimates were used for survival analysis. Cox regression was used in a single-factor analysis to identify the factors affecting DFS in stage IA NSCLC.

Results: After initial screening, 730 patients were enrolled in this study, with 186 and 544 patients in the CTNB group and the non-CTNB group, respectively. After PSM, 186 patients were eventually included in each group. No significant differences in basic clinical features were identified between the two groups (P>0.05). The rates of recurrence were 17.2% and 14.0% in the CTNB and non-CTNB groups (χ²=0.735, P=0.391), respectively. No notable differences in DFS (χ²=1.895, P=0.173) or overall survival (OS, χ²=1.785, P=0.182) were observed. Lung adenocarcinoma [hazard ratio (HR), 0.167, P=0.001] and lesion size (>2 cm) (HR, 2.712, P=0.000) were identified as risk factors for DFS in stage IA NSCLC.

Conclusions: CTNB does not increase the incidence of recurrence in stage IA NSCLC or affect patient survival; therefore, it is not a risk factor for DFS. Lung adenocarcinoma and lesion size are risk factors for DFS.

Keywords: Computed tomography-guided needle biopsy (CTNB); disease-free survival (DFS); stage IA non-small cell lung cancer (stage IA NSCLC).