氩氦刀冷冻消融与射频消融对Ⅰ期非小细胞肺癌的疗效对比分析

Safety and efficacy of cryoablation versus radiofrequency ablation for stageⅠnon-small-cell lung cancer

目的对比氩氦刀冷冻消融(CYA)与射频消融(RFA)治疗Ⅰ期非小细胞肺癌(NSCLC)的安全性和有效性。方法回顾性分析2014年1月至2019年1月符合纳入标准的郑州大学第一附属医院90例Ⅰ期NSCLC患者的临床资料,其中男48例,女42例,年龄39~85(63.6±10.1)岁。根据治疗方法不同分为CYA组(38例)和RFA组(52例)。对比分析2组患者手术持续时间、术中疼痛情况、局部进展率及并发症发生率,采用Kaplan-Meier方法进行生存分析,Log-rank检验比较生存曲线差异。结果两组患者基线资料差异无统计学意义(均P>0.05)。CYA组手术时间长于RFA组[(73.5±17.2)比(51.4±18.7)min,P<0.001],CYA组疼痛视觉模拟评分低于RFA组[0.53±0.89)比(3.44±2.44)分,P<0.001)]。CYA组和RFA组的中位随访时间分别为53个月和52个月。随访期间,CYA组和RFA组的局部进展率差异无统计学意义[31.6%(12/38)比25.0%(13/52),P=0.491]。两组中位肿瘤无进展生存期(PFS)差异无统计学意义[51(95%CI:40.3~55.0)个月比44(95%CI:37.2~54.1)个月,P=0.649];两组中位总生存期(OS)均未达到。两组常见的并发症为气胸、出血和胸腔积液,CYA组总的并发症发生率与RFA组差异无统计学意义[42.1%(16/38)比28.8%(15/52),P=0.191],其中CYA组胸腔积液发生率高于RFA组[26.3%(10/38)比5.8%(3/52),P=0.006],气胸和出血的发生率差异无统计学意义[13.3%(5/38)比13.5%(7/52)和15.8%(6/38)比9.6%(5/52),均P>0.05]。结论CYA和RFA治疗Ⅰ期NSCLC患者的有效性和安全性差异无统计学意义,CYA术中疼痛相对较轻,但手术持续时间长。

Objective To compare the safety and efficacy of cryoablation(CYA)and radiofrequency ablation(RFA)for stageⅠnon-small cell lung cancer(NSCLC).Methods From January 2014 to January 2019,90 eligible patients[48 males,42 females,age:39-85(63.6±10.1)years]in the First Affiliated Hospital of Zhengzhou University met the inclusion criteria were retrospectively analyzed.They were divided into 2 groups according to different treatment methods(group CYA and group RFA).The duration of operation,intraoperative pain,local tumor progression rate and the incidence of complications were compared.The progression-free survival(PFS)and overall survival(OS)of the 2 groups were estimated by Kaplan-Meier curves,and were compared by using log-rank test.Results The clinical data and tumor situation of the patients between two groups did not show significant differences.The mean duration of operation for group CYA was longer than that for group RFA[(73.5±17.2)min vs(51.4±18.7)min,P<0.001];the mean intraoperative visual analogue score(VAS)for group CYA was lower than that for group RFA(0.53±0.89 vs 3.44±2.44,P<0.001).The median follow-up period time were 53 months and 52 months for group CYA and RFA.At the end of the study,The local tumor progression rate was 31.6%(12/38)and 25.0%(13/52)for group CYA and group RFA,the difference were not statistically(P=0.491).There was no statistical difference for progress-free survival(PFS)between group CYA and group RFA[51(95%CI:40.3-55.0)months)vs 44(95%CI:37.2-54.1)months,P=0.649].The median OS was not reached in both groups.The most common complications observed in the two groups were pneumothorax,hemorrhage and pleural effusion.There was no statistical difference in the incidence rates[42.1%(16/38)for group CYA vs 28.8%(15/52)for group RFA,P=0.191].The incidence rate of pleural effusion for group CYA was higher than that for group RFA[26.3%(10/38)vs 5.8%(3/52),P=0.006].The incidence rates of pneumothorax and hemorrhage had no statistical difference between the two groups[13.3%(5/38)vs 13.5%(7/52)and 15.8%(6/38)vs 9.6%(5/52),all P>0.05].Conclusion Compared with RFA,CYA shows no significant differences in the same efficacy and safety for treating patients with stageⅠNSCLC,with less intraoperative pain but longer operative duration.