CT引导经皮与CBCT引导经支气管消融治疗多原发肺癌有效性和安全性的回顾性研究

A retrospective study to evaluate the efficacy and safety of CT-guided percutaneous and cone beam CT-guided transbronchial ablation for multiple primary lung cancer

目的初步探讨CT引导经皮与锥形束CT引导经支气管消融治疗多原发肺癌(multiple primary lung cancer,MPLC)的有效性和安全性。方法回顾性分析上海市胸科医院2020年5月—2022年6月符合入排标准的MPLC患者的临床基本信息、治疗与随访等资料,依据消融路径不同分为经皮消融组和经支气管消融组。结果一共纳入13例MPLC患者26个病灶,经皮消融14个,经支气管消融12个。两组在病灶性质、位置、肺野和肺窗长径上的差异无统计学意义,经支气管消融组病灶距壁层胸膜距离长于经皮消融组,差异具有统计学意义(P=0.03)。经皮消融组和经支气管消融组的中位随访时间分别为13个月和12个月,在3个月完全消融率(100.0%比83.3%)、1年局部控制率(100.0%比91.7%)和严重并发症发生率(7.1%比16.7%)上的差异均无统计学意义。两组在轻微并发症发生率上的差异具有统计学意义(P=0.02),经皮消融(50.0%)高于经支气管消融(0.0%)。结论经皮消融和经支气管消融具有较高的有效性和安全性,且后者轻微并发症发生率更低,两者可相互补充,为不适合或拒绝手术的早期MPLC患者提供个性化的微创治疗策略。

Objective To evaluate the efficacy and safety of computed tomography(CT)-guided percutaneous and cone beam CT-guided transbronchial ablation in the treatment of early multiple primary lung cancer(MPLC).Methods Retrospective analysis was performed on patients who met inclusion criteria in Shanghai Chest Hospital between May 2020 to June 2022.According to ablation pathway,lesions were divided into two groups:percutaneous ablation group and transbronchial ablation group.Results A total of 13 MPLC patients with 26 lesions were included(14 percutaneous ablation and 12 transbronchial ablation).There were no statistically significant differences in solid component,lesion location,lung field and lesion size between the two groups.The distance from the parietal pleura in the transbronchial ablation group was longer than that in percutaneous ablation group(P=0.03).The median follow-up period time were 13 months and 12 months for group percutaneous ablation and transbronchial ablation.No significant differences were found in 3-month complete ablation rate(100.0%vs.83.3%),1-year local control rate(100.0%vs.91.7%)and severe complication rate(7.1%vs.16.7%).The minor complication rate in percutaneous ablation group was higher than that in transbronchial ablation group(50.0%vs 0.0%,P=0.02).Conclusions Percutaneous ablation and transbronchial ablation have high efficacy and safety,and the latter involves lower minor complication rate.They complement each other,which provide the individualized treatments for early MPLC patients who are not suitable for or refuse surgery.