CT引导下经皮肺穿刺微波消融治疗非小细胞肺癌(36例临床疗效分析)

目的探讨CT引导下经皮肺穿刺微波消融(PMAT)治疗非小细胞肺癌(NSCLC)的临床疗效和安全性。方法回顾性分析在我科行PMAT的36例NSCLC患者,分为直径3 cm及以下组(小病变组,19例),直径3~5 cm组(中病变组,11例)和直径大于5 cm组(大病变组,6例),按照RECIST标准对肿瘤的局部疗效进行评价,随访3~50个月,采用Kaplan-Meier法计算生存期,并比较不同肿瘤直径患者微波消融术后1年、2年、3年和4年生存率差异。结果 36例患者均成功完成微波消融术,所有均未出现严重并发症。中位随访24个月内,患者肿瘤局部进展率为27.8%,小病变组和中病变组局部进展率无统计学差异(21.5%比21.7%,χ~2=0.036,P=0.850);大病变组局部进展率明显高于直径≤5 cm患者(χ~2=4.360,P=0.037;χ~2=3.996,P=0.046)。全组患者中位生存时间27个月,1~4年生存率分别为83.3%、55.6%、36.1%和19.4%;小病变组与中病变组中位生存时间均为36个月,1~4年生存率比较无明显统计学差异(89.5%、63.2%、47.4%、26.3%比81.8%、54.5%、45.5%、22.7%,χ~2=0.045,P=0.832);大病变组中位生存时间为15个月,其1年、2年生存率分别为66.7%和33.3%明显低于小病变组和中病变组,差异有统计学意义(χ~2=7.858,P=0.005;χ~2=4.494,P=0.034)。微波消融术中及术后1个月无患者死亡,未见针道内出血、胸腔内出血和针道肿瘤种植转移情况。消融后综合征是最常见并发症(9例),其次为微波消融术中局部疼痛和热感(7例),4例患者术后胸部CT扫描发现轻度气胸。结论CT引导下经皮肺穿刺微波消融术治疗NSCLC疗效确切、安全可靠,有望成为肿瘤直径≤5 cm的不可手术患者的一线治疗手段。

Clinical evaluation of CT-guided percutaneous microwave ablation of non-small cell lung cancer

Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (PMAT) in the treatment of non-small cell lung cancer (NSCLC). Methods 36 patients with NSCLC were divided according to the diame-ters of the tumor masses into small (<3 cm, 19 patients), medium (3-5 cm, 11), and large (>5 cm, 6) groups. The curative effect of local tumor was evaluated using RECIST standard and the survival time was calculated by Kaplan-Meier method after 3-50 month follow-up. The survival rates of patients with different tumor diameters were compared at 1, 2, 3 and 4 years after PMAT. Results All 36 patients underwent PMAT successfully without serious complications. The local tumor progression rate was 27.8％ in the me-dian follow-up of 24 months without significant difference (χ2=0.036, P=0.850) between the small (21.5％) and medium (21.7％) groups. The tumor progression rate of the large group was significantly higher than that of small (χ2=4.360,P=0.037) and medium (χ2=3.996, P=0.046) groups. The median survival time was 27 months for all patients, 36 months for the small and medium groups, and 15 months for the large group. The overall survival rates were 83.3％, 55.6％, 36.1％, and 19.4％ in 1-4 years, respectively. There was no significant difference (χ2=0.045, P=0.832) in survival rates of small (89.5％, 63.2％, 47.4％, 26.3％) and medium groups (81.8％, 54.5％, 45.5％, 22.7％) at 1-4 years. The survival rates at 1 (χ2=7.858, P=0.005) and 2 (χ2=4.494, P=0.034) years of the large group were significantly lower than the small and medium groups. At 1 month after PMAT, there was no patient death, intracavitary bleeding, bleeding or tumor seeding along the needle track. Ablation syndrome was the most common complica-tion (9 patients), followed by local pain and heat (7), and small pneumothorax (4). Conclusion CT-guided PMAT is effective and safe as the first-line treatment of patients with NSCLC smaller than 5 cm.