• Tadashi Sakane, Koichiro Nakajima, Hiromitsu Iwata, Tomoharu Nakano, Emi Hagui, Masanosuke Oguri, Kento Nomura, Yukiko Hattori, Hiroyuki Ogino, and Hiroshi Haneda.
• Department of Thoracic Surgery, Nagoya City University West Medical Center, Nagoya, Japan. Electronic address: t.sakane@med.nagoya-cu.ac.jp.
• J. Thorac. Cardiovasc. Surg. 2023 Dec 1; 166 (6): 14901501.e21490-1501.e2.

ObjectiveLobectomy is the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). In recent years, an increasing number of patients with lung cancer have been treated using proton therapy (PT). We conducted a propensity score-matched analysis to compare the treatment outcomes of these 2 modalities.MethodsWe retrospectively reviewed data from 275 patients with histologically confirmed clinical stage I NSCLC who underwent lobectomy (n = 206) or PT (n = 69) at our institution from July 2013 to December 2020. The end points were overall survival (OS), cause-specific survival, recurrence-free survival (RFS), local control, regional lymph node control, and distant control. Propensity score matching was performed to reduce selection bias in the 2 groups.ResultsThe matched cohort consisted of 59 patients who underwent lobectomy and 59 patients who underwent PT with a median follow-up period of 50 months. There were no significant differences in OS (P = .26), cause-specific survival (P = .33), RFS (P = .53), local control (P = .41), regional lymph node control (P = .98), and distant control (P = .31). In the lobectomy and PT groups, the 5-year OS rate was 85.8% and 79.1%, respectively, the RFS rate was 82.3% and 77.8%, and the local control rate was 92.1% and 96.6%.ConclusionsWe found no difference in survival or disease control between lobectomy and PT in patients with histologically confirmed clinical stage I NSCLC. Despite these findings, the potential for unmeasured confounding factors remains, and randomized control trials are needed to better compare these treatment modalities.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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