Three-Year Mortality Rates Compared in Early-Stage Lung Cancer Study
An estimated 21.6% of early-stage non-small cell lung cancer patients who undergo surgery die of any cause within three years, compared with 30.3% of those receiving stereotactic ablative radiotherapy, according to findings published in the Journal of Clinical Oncology. The study analyzed health records for 12,546 individuals diagnosed with early-stage NSCLC in England between 2015 and 2020. Researchers utilized an emulated target trial design to compare surgical resection directly against SABR, a localized high-dose radiation therapy.
Among those study participants, 10,247 underwent surgery while 2,299 received SABR. The resulting 8.8 percentage point gap in all-cause mortality highlights a distinct survival advantage for surgical intervention in broader patient populations. The study was supported by the National Institute for Health and Care Research Biomedical Research Centre in Manchester, addressing a persistent clinical evidence gap where previous randomized trials struggled with low recruitment rates.
Direct comparative evidence between SABR and surgery has remained scarce because earlier randomized trials failed to gather enough participants. To bypass this recruitment hurdle, investigators turned to real-world medical data. They linked England’s National Cancer Registry with hospital and radiotherapy records to emulate the parameters of a randomized controlled trial. Investigators described this methodological approach as a world-first comparison of the two modalities.
The study also evaluated cancer-specific outcomes. The average estimates for three-year lung cancer-specific mortality reached 20.6% following SABR versus 14.5% after surgery. Cancer recurrence estimates were also higher following SABR than surgery, though neither of those specific metrics reached statistical significance. National health officials estimate that roughly 2,000 people diagnosed with early-stage lung cancer in England each year qualify for either treatment path.
Patient Age Shifts Treatment Efficacy and Curative Intent
Age alters the comparative effectiveness of these two interventions. Among patients aged 80 years and older, researchers found no clinically meaningful difference in three-year all-cause mortality between SABR and surgery. This specific subset indicates that SABR can serve as a viable alternative curative-intent treatment for older populations.
SABR already holds a recommendation as a curative-intent option for individuals with early-stage NSCLC who are medically unfit for surgery or simply decline it. Data shows that approximately one in five eligible patients in England currently receive SABR, a utilization rate that has climbed in recent years. Richard Grieve, professor of health economics at LSHTM and co-author of the study, noted in a news release that surgery remains the primary treatment most likely to improve survival rates for eligible patients, aligning with current NICE guidance.
Frequently Asked Questions About SABR and Surgery for NSCLC
How many patients were included in the emulated trial?
The study evaluated data from 12,546 people diagnosed with early-stage NSCLC in England between 2015 and 2020. Of that group, 10,247 underwent surgery and 2,299 received SABR.
What did cancer-specific analyses reveal about recurrence?
Researchers reported higher estimates of cancer recurrence following SABR compared to surgery, alongside a 20.6% three-year lung cancer-specific mortality rate for SABR versus 14.5% for surgery. However, these specific differences were not statistically significant.
When was the study published?
The research was published online on November 2, 2026, in the Journal of Clinical Oncology under DOI: 10.1200/JCO-26-00399.