微波消融治疗非小细胞肺癌根治术后肺寡转移瘤的预后分析

目的 评价CT引导下经皮穿刺微波消融(MWA)治疗非小细胞肺癌根治术后肺寡转移瘤的临床疗效,探讨影响患者生存预后的相关因素。 方法 回顾性分析2014年1月至 2018年12月确诊的36例非小细胞肺癌术后肺寡转移瘤患者的临床资料。所有患者均通过CT引导下经皮穿刺MWA治疗寡转移瘤。术后第4~7天、1个月及之后的每3个月进行随访,并进行胸部CT检查。Kaplan-Meier法计算总生存率、无进展生存率、局部无进展率,Log-rank 检验比较各组间差别,Cox多因素分析判定独立的危险因素。 结果 所有患者均成功进行了CT引导下经皮穿刺MWA,术后5例(13.9%)出现并发症,其中气胸3例、胸痛2例,所有并发症均已在患者出院前被治愈。Kaplan-Meier法及Log-rank检验结果显示,寡转移瘤直径≤3 cm的患者,其3年无进展生存率、3年局部无进展率分别为11.1%、11.1%;寡转移瘤直径>3 cm的患者,其3年无进展生存率、3年局部无进展率分别为0.0%,0.0%;差异均具有统计学意义(P<0.001)。Cox多因素分析结果显示,寡转移瘤直径>3 cm是患者MWA术后3年无进展生存(P<0.001)、3年局部无进展(P<0.001)的独立危险因素;患者的临床特征与3年总生存率之间无显著相关性。 结论 CT引导下经皮穿刺MWA可以安全、有效地治疗非小细胞肺癌根治术后肺内寡转移瘤,尤其对于直径≤3 cm的寡转移瘤,可有效延缓其局部进展。

Prognosis of microwave ablation for pulmonary oligometastases after radical resection of non-small cell lung cancer

Objective To evaluate the clinical efficacy of computed tomography(CT)-guided percutaneous microwave ablation(MWA)in the treatment of pulmonary oligometastases after radical resection of non-small cell lung cancer(NSCLC), and to analyze factors affecting survival. Methods The clinical data of 36 patients with pulmonary oligometastases after radical resection of NSCLC during Jan. 2014 and Dec. 2018 were retrospectively analyzed. All patients received CT-guided percutaneous microwave ablation to treat oligometastases. Follow-up and CT examinations were performed on 4-7 days, 1 month and every 3 months after ablation. The overall survival(OS), progression-free survival(PFS)and local progression-free rate were calculated with the Kaplan-Meier method. The differences among groups were compared with Log-rank test, and the independent risk factors were determined with Cox multivariate analysis. Results All patients underwent MWA successfully. Complications occurred in 5 cases(13.9%), including pneumothorax in 3 cases and chest pain in 2 cases. All complications were cured before discharge. The results of Kaplan-Meier and Log-rank test showed that for patients with oligometastatic tumor diameter ≤3 cm, the 3-year PFS and 3-year local progression-free rate were 11.1% and 11.1%, respectively, while for patients with oligometastatic tumor diameter >3 cm, the 3-year PFS and 3-year local progression-free rate were 0.0% and 0.0%, respectively, with statistically significant difference(P<0.001). Cox multivariate analysis showed that oligometastatic tumor diameter >3 cm was an independent risk factor for 3-year PFS(P<0.001)and 3-year local progression-free rate(P<0.001). Besides, no correlation was found between the clinical characteristics and 3-year OS. Conclusion CT-guided percutaneous MWA is safe and effective in the treatment of pulmonary oligometastases after radical resection of NSCLC, and it is practical to delay the local progression of oligometastatic tumors ≤3 cm in diameter.