{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:24:43Z","timestamp":1760059483806,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health and Welfare, Republic of Korea","award":["HC23C0212"],"award-info":[{"award-number":["HC23C0212"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: With rising life expectancy and widespread lung cancer screening, early-stage non-small cell lung cancer (NSCLC) incidence has increased. While surgery is the standard treatment for operable stage I NSCLC, many patients are ineligible due to age or comorbidities. Stereotactic body radiotherapy (SBRT) has achieved good primary tumor control rates and overall survival. This study compares the outcomes of SBRT and surgery for stage I NSCLC using propensity score overlap-weighted dataset. Methods: This retrospective study analyzed clinical stage I NSCLC patients treated at a tertiary hospital from 2012 to 2021. Baseline differences between SBRT and surgery groups were adjusted using overlap weighting. AI-based CT analysis (CT AI-CAD) assessed tumor characteristics, verified by radiologists. Primary outcomes were 5-year cumulative incidence of recurrence and overall survival, with subgroup analyses based on tumor features. Results: Of 1474 patients, 1258 underwent surgery, and 216 received SBRT. After overlap weighting, baseline characteristics were well balanced. The 5-year cumulative incidence of recurrence and OS showed no statistically significant differences between SBRT and surgery groups (recurrence: 16.2% vs. 16.1%; OS: 80.5% vs. 82.9%). Further AI-based CT subgroup analysis showed no significant differences in recurrence rates across tumor features. A solid tumor diameter associated with a significant increase in recurrence was identified as 16.6 mm for SBRT and 18.6 mm for surgery. Conclusions: After overlap weighting, SBRT and surgery showed no statistically significant differences in treatment outcomes in stage I NSCLC. These findings may help guide the timing and selection of safe and effective treatment approaches.<\/jats:p>","DOI":"10.3390\/cancers17122015","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T05:52:47Z","timestamp":1750139567000},"page":"2015","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Stereotactic Body Radiotherapy and Surgery for Stage I Lung Cancer: A Multidisciplinary Cohort Study Utilizing Propensity Score Overlap Weighting and AI-Based CT Imaging Analysis"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-3442","authenticated-orcid":false,"given":"Eun Hye","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2078-5832","authenticated-orcid":false,"given":"Young Joo","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5087-786X","authenticated-orcid":false,"given":"Jong Won","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jisu","family":"Moon","sequence":"additional","affiliation":[{"name":"BIostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangjoon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8702-881X","authenticated-orcid":false,"given":"Chang Geol","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2106-6856","authenticated-orcid":false,"given":"Hong In","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byung Jo","family":"Park","sequence":"additional","affiliation":[{"name":"Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin Gu","family":"Lee","sequence":"additional","affiliation":[{"name":"Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dae Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1949-4798","authenticated-orcid":false,"given":"Seung Hyun","family":"Yong","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9966-5157","authenticated-orcid":false,"given":"Jaeho","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3281-5744","authenticated-orcid":false,"given":"Eun Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e069008","DOI":"10.1136\/bmj-2021-069008","article-title":"Association of computed tomography screening with lung cancer stage shift and survival in the united states: Quasi-experimental study","volume":"376","author":"Potter","year":"2022","journal-title":"BMJ"},{"unstructured":"Health Insurance Review and Assessment Service (2025, March 01). 5th Lung Cancer Adequacy Assessment Report. 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