The incidence of early-stage non-small cell lung cancer (NSCLC) is expected to increase substantially in the middle-aged and elderly population due to demographic trends and improvements in computerized CT scanning technology. However, to date, there are no clinical trials comparing these most common treatments for NSCLC. With this in mind, in order to clarify the clinical characteristics and survival outcomes of the 3 most commonly treated middle-aged and elderly patients with early-stage NSCLC, Shervin M. Shirvani et al. from the United States conducted a study, the results of which were published in the recent issue of JAMA. The study included 9093 patients with early-stage, lymph node-negative NSCLC from January 1, 2003 to December 31, 2009. baseline characteristics of patients treated with lobectomy, sublobar resection, or stereotactic ablative radiotherapy (SABR) were determined by surveillance, epidemiologic, and end-result data. Overall and lung cancer-specific survival was compared by Medicare statement as of December 31, 2012. Proportional risk regression models and propensity matching analyses were used to correct for patient, tumor, and environmental factors. The study found that the median age was 75 years, 79.3% were lobectomized, 16.5% were sublobar resected, and 4.2% were SABR. unadjusted 90-day mortality lobectomy (4.0%) group was the highest, followed by sublobar resection (3.7%) and SABR (1.3%). 3-year unadjusted mortality lobectomy group (25.0%) was the lowest, followed by sublobar resection (35.3%) and SABR (45.1%). Proportional risk regression models indicated that sublobar resection was associated with poor overall prognosis and lung cancer-specific survival compared with lobectomy. Propensity matching analysis reiterated the findings regarding overall survival and lung cancer-specific survival. Proportional risk regression models with higher overall survival in the SABR group than in the lobectomy group in the first 6 months after diagnosis, but poorer subsequent prognosis. Propensity-matched analysis of overall survival was similar in the highly matched SABR and lobectomy groups. This study suggests that older patients with early-stage non-small cell lung cancer who undergo lobectomy have a better prognosis than lobectomy. Propensity-matched analysis suggests that SABR may be a good option for very advanced age and for patients with multiple comorbidities in combination.