微波消融与射频消融治疗非小细胞肺癌的疗效及癌性疼痛控制研究

Clinical efficacy and cancer pain control of microwave ablation and radiofrequency ablation under neoadjuvant chemotherapy for non-small cell lung cancer

目的探讨新辅助化疗下微波消融(microwave ablation,MWA)与射频消融(radiofrequency ablation,RFA)治疗非小细胞肺癌的临床疗效及癌性疼痛控制的效果。方法采用回顾性分析,选取2017年1月至2021年1月在枣庄市胸科医院接受新辅助化疗联合MWA或RFA治疗的81例非小细胞肺癌患者,其中39例患者采用新辅助化疗联合RFA治疗(RFA组),42例患者采用新辅助化疗联合MWA治疗(MWA组)。RFA组中,男22例,女17例,年龄(62.34±4.78)岁;MWA组中,男23例,女19例,年龄(61.79±4.92)岁。对比分析两组患者近期疗效、肿瘤标志物水平、术后疼痛评分、止疼药使用情况、并发症发生率等指标。采用t检验、χ^(2)检验或Fisher精确检验进行统计分析,重复测量方差分析用于评价各项指标变化趋势。结果MWA组和RFA组疾病控制率和客观缓解率比较[90.48%(38/42)比92.31%(36/39)、83.33%(35/42)比82.05%(32/39)],差异均无统计学意义(均P>0.05)。治疗后,两组血清神经元特异性烯醇化酶(NSE)、鳞状细胞癌抗原(SCCA)、细胞角蛋白片段21-1(CYFRA21-1)、癌胚抗原(CEA)浓度水平均有所下降,但两组间差异均无统计学意义(均P>0.05);两组患者治疗前视觉模拟量表(VAS)评分对比差异无统计学意义(P>0.05),随着时间的延长呈下降趋势,治疗后24 h、72 h、4周,MWA组VAS评分显著低于RFA组,两组比较差异均有统计学意义(均P<0.05);治疗后MWA组的止痛药使用率为7.14%(3/42),明显低于RFA组的23.08%(9/39),差异有统计学意义(P<0.05);MWA组并发症发生率为26.19%(11/42),RFA组为30.77%(12/39),差异无统计学意义(P>0.05)。结论在近期疗效、并发症发生率、肿瘤标志物指标中MWA和RFA治疗非小细胞肺癌的临床疗效相似,在患者术后癌性疼痛的控制中止痛药的使用情况MWA优于RFA,MWA能够改善姑息性治疗患者的生存质量,在肺癌消融治疗中显示出巨大的潜力。

Objective To investigate the clinical efficacy and cancer pain control of microwave ablation(MWA)and radiofrequency ablation(RFA)under neoadjuvant chemotherapy in the treatment of non-small cell lung cancer.Methods The medical records of 81 patients with non-small cell lung cancer who received neoadjuvant chemotherapy combined with MWA or RFA in Zaozhuang Chest Hospital between January 2017 and January 2021 were retrospectively analyzed.Of the 81 patients,39 took RFA(an RFA group),and 42 MWA(an MWA group).There were 22 males and 17 females in the RFA group;they were(62.34±4.78)years old.There were 23 males and 19 females in the MWA group;they were(61.79±4.92)years old.The short-term efficacies,tumor marker levels,postoperative pain scores,usages of painkillers,and incidences of complications were compared between the two groups and analyzed.t test,χ^(2) test,and Fisher's exact test were used for the statistical analysis.Repeated measure analysis of variance was used to evaluated the change trend of each indicator.Results There were no statistical differences in the disease control rate and objective response rate between the MWA group and the RFA group[90.48%(38/42)vs.92.31%(36/39)and 83.33%(35/42)vs.82.05%(32/39);both P>0.05].After the treatment,the serum levels of neuron specific enolase(NSE),squamous cell carcinoma antigen(SCCA),cytokeratin fragment 21-1(CYFRA21-1),and carcinoembryonic antigen(CEA)decreased in both groups,but there were no statistical differences between the two groups(all P>0.05).There was no statistical difference in the score of Visual Analogue Scale(VAS)between the two groups before the treatment(P>0.05);with the prolongation of time,the VAS scores in both group decreased;the VAS scores 24 and 72 h and 4 weeks after the treatment in the MWA group were significantly lower than those in the RFA group,with statistical differences(P<0.05).After the treatment,the usage rate of analgesics in the MWA group was significantly lower than that in the RFA group[7.14%(3/42)vs.23.08%(9/39)],with a statistical difference(P<0.05).The incidences of complications in the MWA group and the RFA group were 26.19%(11/42)and 30.77%(12/39),respectively,with no statistical difference(P>0.05).Conclusions MWA has a similar clinical efficacy with RFA in treating non-small cell lung cancer.MWA is better in controlling postoperative cancer pain than RFA,and can improve the quality of life of patients taking palliative treatment,so it has great potential in the treatment of lung cancer.