Comparison of surgery and stereotactic body radiation therapy for clinical stage I NSCLC: a propensity score-matched analysis from a single institution.

Background: Lobectomy with mediastinal lymph node dissection is the standard treatment for clinical stage I non-small cell lung cancer (NSCLC). For medically inoperable patients or those unwilling to undergo surgery, stereotactic body radiation therapy (SBRT) has emerged as an alternative. This study aimed to compare the clinical outcomes of SBRT and surgery in patients with stage I NSCLC treated at a single institution. Methods: We retrospectively reviewed patients diagnosed with clinical stage I NSCLC at Ajou University Hospital from 2016 to 2021. Patients who had prior malignancies or double primary lung cancers were excluded. A total of 214 patients were included, and propensity score matching (PSM) (1:3) was applied to adjust for confounding variables, resulting in 31 patients in the SBRT group and 93 in the surgery group. Clinical outcomes were compared, including overall survival (OS), disease-free survival (DFS), and recurrence patterns. Results: After matching, the 3-year OS was similar between the SBRT and surgery groups (90.0% Conclusions: In clinical stage I NSCLC, SBRT showed comparable OS and distant recurrence outcomes to surgery, although it was associated with a higher local recurrence rate. For elderly patients or those with high surgical risk, SBRT may be considered an effective alternative.