您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (12): 63-68.doi: 10.6040/j.issn.1671-7554.0.2022.0342

• • 上一篇    

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

马瑞杰1,朱良明1,左太阳1,李春海2,张楠1,孙志钢1   

  1. 1.山东大学附属济南市中心医院胸外科, 山东 济南 250013;2. 山东大学齐鲁医院放射科, 山东 济南 250012
  • 发布日期:2022-12-01
  • 通讯作者: 孙志钢. E-mail:sunszg@126.com

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

MA Ruijie1, ZHU Liangming1, ZUO Taiyang1, LI Chunhai2, ZHANG Nan1, SUN Zhigang1   

  1. 1. Department of Thoracic Surgery, Jinan Central Hospital, Shandong University, Jinan 250013, Shandong, China;
    2. Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2022-12-01

PDF (PC)

32

摘要： 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。

关键词: 微波消融, 热消融, 寡转移瘤, 寡复发, 非小细胞肺癌

Abstract: 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.

Key words: Microwave ablation, Thermal ablation, Oligometastase, Oligorecurrence, Non-small cell lung cancer

中图分类号: 

  • R734.2
[1] Rangamuwa K, Leong T, Weeden C, et al. Thermal ablation in non-small cell lung cancer: a review of treatment modalities and the evidence for combination with immune checkpoint inhibitors[J]. Transl Lung Cancer Res, 2021,10(6): 2842-2857.
[2] Vespro V, Bonanno MC, Andrisani MC, et al. CT after lung microwave ablation: normal findings and evolution patterns of treated lesions[J]. Tomography, 2022, 8(2): 617-626.
[3] Chan MV, Huo YR, Cao C, et al. Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage I non-small cell lung cancer(NSCLC): a systematic review and meta-analysis[J]. Eur Radiol, 2021, 31(7): 5421-5433.
[4] Weichselbaum RR, Hellman S. Oligometastases revisited[J]. Nat Rev Clin Oncol, 2011, 8(6): 378-382.
[5] Niibe Y, Chang JY, Onishi H, et al. Oligometastases/oligo-recurrence of lung cancer[J]. Pulm Med, 2013, 2013: 438236. doi: 10.1155/2013/438236.
[6] Martini N, Melamed MR. Multiple primary lung cancers[J]. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
[7] Shen KR, Meyers BF, Larner JM, et al. Special treatment issues in lung cancer: ACCP evidence-based clinical practice guidelines(2nd edition)[J]. Chest, 2007, 132(3 Suppl): 290S-305S.
[8] Ni Y, Peng J, Yang X, et al. Multicentre study of microwave ablation for pulmonary oligorecurrence after radical resection of non-small-cell lung cancer[J]. Br J Cancer, 2021, 125(5): 672-678.
[9] Chetty IJ, Doemer AJ, Dolan JL, et al. MRI-guided Radiotherapy(MRgRT)for treatment of oligometastases: review of clinical applications and challenges[J]. Int J Radiat Oncol Biol Phys, 2022, S0360-3016(22)00745-3.
[10] Han SJ, Cho S, Yum S, et al. Surgical treatment of pulmonary oligorecurrence after curative resection for non-small-cell lung cancer[J]. Interact Cardiovasc Thorac Surg, 2020, 30(1): 18-23.
[11] Wu AJ, Garay E, Foster A, et al. Definitive radiotherapy for kocal recurrence of NSCLC after surgery[J]. Clin Lung Cancer, 2017, 18(3): e161-e168.
[12] Uhlig J, Mehta S, Case MD, et al. Effectiveness of thermal ablation and stereotactic radiotherapy based on stage I lung cancer histology[J]. J Vasc Interv Radiol, 2021, 32(7): 1022-1028.
[13] Habibi M, Berger RD, Calkins H. Radiofrequency ablation: technological trends, challenges, and opportunities[J]. Europace, 2021, 23(4): 511-519.
[14] Li G, Xue M, Chen W, et al. Efficacy and safety of radiofrequency ablation for lung cancers: a systematic review and meta-analysis[J]. Eur J Radiol, 2018, 100: 92-98. doi: 10.1016/j.ejrad.2018.01.009.
[15] Tselikas L, Garzelli L, Mercier O, et al. Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease[J]. Diagn Interv Imaging, 2021, 102(1): 19-26.
[16] 中国临床肿瘤学会 CSCO 肿瘤消融治疗专家委员会, 中国医师协会肿瘤消融治疗技术专家组, 中国抗癌协会肿瘤消融治疗专业委员会, 等. 影像引导下热消融治疗原发性和转移性肺部肿瘤临床实践指南(2021年版)[J]. 中华内科杂志, 2021,60(12): 1088-1105.
[17] Sparchez Z, Mocan T, Radu P, et al. Microwave ablation in the treatment of liver tumors. A better tool or simply more power?[J]. Med Ultrason, 2020, 22(4): 451-460.
[18] Bailey CW, Sydnor MJ. Current state of tumor ablation therapies[J]. Dig Dis Sci, 2019, 64(4): 951-958.
[19] Wei Z, Yang X, Ye X, et al. Microwave ablation plus chemotherapy versus chemotherapy in advanced non-small cell lung cancer: a multicenter, randomized, controlled, phase III clinical trial[J]. Eur Radiol, 2020, 30(5): 2692-2702.
[20] Londero F, Grossi W, Parise O, et al. The Impact of preoperative inflammatory markers on the prognosis of patients undergoing surgical resection of pulmonary oligometastases[J]. J Clin Med, 2020, 9(10): 3378. doi: 10.3390/jcm9103378.
[21] Cheng G, Shi L, Qiang W, et al. The safety and efficacy of microwave ablation for the treatment of CRC pulmonary metastases[J]. Int J Hyperthermia, 2018, 34(4): 486-491.
[22] Meng M, Han X, Li W, et al. CT-guided microwave ablation in patients with lung metastases from breast cancer[J]. Thorac Cancer, 2021, 12(24): 3380-3386.
[23] Izzo F, Granata V, Grassi R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update[J]. Oncologist, 2019, 24(10): e990-e1005.
[24] Chen B, Li W, Liu Y, et al. The efficacy and complications of computed tomography guided microwave ablation in lung cancer[J]. Ann Palliat Med, 2020, 9(5): 2760-2765.
[25] Ye X, Fan W, Wang H, et al. Expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors(2018 edition)[J]. J Cancer Res Ther, 2018, 14(4): 730-744.
[26] Chen B, Li W, Liu Y, et al. The efficacy and complications of computed tomography guided microwave ablation in lung cancer[J]. Ann Palliat Med, 2020, 9(5): 2760-2765.
[27] 丁荣, 牛有权, 黄明, 等. 肺部恶性肿瘤热消融系列并发症防治的文献复习[J]. 中华介入放射学电子杂志, 2021, 9(4): 434-439. DING Rong, NIU Yiuquan, HUANG Ming, et al. Prevention and treatment of a series of complications of thermal ablation in the treatment of lung tumors: a review of the literature[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 9(4): 434-439.
[28] Xu S, Qi J, Li B, et al. Risk prediction of pneumothorax in lung malignancy patients treated with percutaneous microwave ablation: development of nomogram model[J]. Int J Hyperthermia, 2021, 38(1): 488-497.
[1] 秦静,杨飞,陈谦,夏涵岱,刘延国,王秀问. 晚期驱动基因阴性、PD-L1表达阴性非鳞非小细胞肺癌一线治疗方案的网状Meta分析[J]. 山东大学学报 (医学版), 2022, 60(7): 74-82.
[2] 陈兆波,方敏,薛浩然,刘春艳. 去泛素化酶USP35促进非小细胞肺癌细胞迁移和侵袭[J]. 山东大学学报 (医学版), 2022, 60(4): 30-37.
[3] 刘会宁,彭军,任迎春,杨光,王文豪,刘金锋,田勍. 34例胸腔镜下肺楔形切除与21例肺段切除对位于肺段P区的ⅠA1期非小细胞肺癌治疗比较[J]. 山东大学学报 (医学版), 2022, 60(11): 38-43.
[4] 丁子琛,王浩桦,周立雯,丛慧文,李承圣,包绮晗,杨毅,王廉源,王素珍,石福艳. 基于贝叶斯累加回归树模型的非小细胞肺癌患者个性化疗效研究[J]. 山东大学学报 (医学版), 2022, 60(10): 92-98.
[5] 刘小璟,夏西燕,肖珂,陈文丹,庄学伟. 外泌体lncRNA OGFRP1在84例非小细胞肺癌中的表达及临床意义[J]. 山东大学学报 (医学版), 2020, 58(11): 71-75.
[6] 魏萍,杜鲁涛,王卿,展垚,谢玉姣,张淑君,段伟丽,王传新. 血清外泌体miR-20b-5p对非小细胞肺癌的诊断价值[J]. 山东大学学报 (医学版), 2019, 57(4): 91-96.
[7] 王伟,刘拥征,李岭. 酸浆苦素B对人非小细胞肺癌细胞增殖、迁移及凋亡的影响[J]. 山东大学学报 (医学版), 2019, 57(3): 13-18.
[8] 王建丽,王筱静,孙玉莲,胡晓乐,栾晓嵘. 吉非替尼联合化疗治疗50例晚期非小细胞肺癌患者的疗效[J]. 山东大学学报 (医学版), 2019, 57(11): 20-26.
[9] 徐淑媛,纪全江,国丽. 血清sEGFR、CEA及Cyfra21-1水平对非小细胞肺癌患者预后的影响[J]. 山东大学学报 (医学版), 2019, 57(10): 107-111.
[10] 郑清月,赵秋红,渠香云,董肇楠,马雪情,贾云莉. 血清外泌体miR-205-5p/miR-152-5p对早期非小细胞肺癌的诊断价值[J]. 山东大学学报 (医学版), 2019, 57(10): 101-106.
[11] 王宁宁,曲琳莉,曹芳丽,梁磊. CT矢状位重建在膈顶部肝肿瘤微波消融治疗中的应用[J]. 山东大学学报（医学版）, 2017, 55(8): 71-75.
[12] 孙启晶,陈方方,李春晓,张才擎. PNI及HGB评估中晚期非小细胞肺癌患者预后的临床价值[J]. 山东大学学报（医学版）, 2017, 55(4): 55-59.
[13] 戴建建,袁冰,张颖,林琦,袁苑,韩明勇. CT引导下125I粒子植入治疗Ⅲ期非小细胞肺癌疗效与并发症的临床观察[J]. 山东大学学报（医学版）, 2017, 55(2): 32-37.
[14] 彭岳,冯振,谢厚耐,王晖,李猛,任万刚,刘通,彭忠民. 61例肺部多发病灶患者的外科治疗[J]. 山东大学学报（医学版）, 2017, 55(11): 42-46.
[15] 王丽丽,霍彬,王磊,汪浩,侯定坤,霍小东,王金焕,臧立,曹强,柴树德,王海涛. 亚肺叶切除联合125I粒子植入治疗早期肺癌有效性的Meta分析与系统评价[J]. 山东大学学报（医学版）, 2017, 55(10): 76-83.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发