CT引导下经皮微波消融或联合^(125)I粒子植入治疗晚期肺癌的临床分析

Clinical Analysis of CT-Guided Percutaneous Microwave Ablation Combined With ^(125)I Seed Implantation in the Treatment of Advanced Lung Cancer

目的 探讨分析计算机断层扫描(computed tomography,CT)引导下经皮微波消融(microwave ablation,MWA)或联合碘125粒子(iodine-125,^(125)I)植入治疗晚期肺恶性肿瘤的临床疗效。方法 共纳入44例行MWA或MWA联合^(125)I粒子植入治疗的Ⅳ期非小细胞肺癌(non small-cell lung cancer,NSCLC)或肺转移瘤患者,按其治疗方式不同分为MWA组28例,联合组(MWA联合^(125)I粒子植入)16例。并对两组患者近期的临床疗效、并发症、功能状态评分(Karnofsky performance status,KPS)及生存的相关因素进行比较。结果 MWA组、联合组的有效率分别为21.43%、56.25%(P<0.05);并发症发生率分别为46.43%、62.50%(P>0.05);治疗后1个月,两组KPS均低于治疗前(P<0.05);治疗后3个月,联合组的KPS评分高于本组治疗前及MWA组同期的评分(P<0.05);生存期的相关因素进行Cox分析,治疗方式[风险比(hazard ratio,HR)=0.400,95%可信区间(confidence interval,CI)0.849~0.957,P=0.048]、术前KPS(HR=0.902,95%CI 0.850~0.957,P=0.001]为保护因素。结论 CT引导下MWA联合^(125)I粒子植入对晚期肺恶性肿瘤的治疗安全可靠,近期临床疗效尚可。

Objective To investigate and analyze the clinical efficacy of computed tomography(CT)-guided microwave ablation(MWA)combined with iodine-125(^(125)I)seed implantation in treating lung malignant tumors.Methods Records of forty-four patients,who were followed up for advanced or metastatic lung cancer treated with MWA or MWA combined with ^(125)I seed implantation from January 2015 to December 2020 in Guangdong Provincial Peoples Hospital,were retrospectively reviewed,28 patients were treated with MWA(MWA group)and 16 patients were treated with MWA combined with ^(125)I seed implantation(combined group).The short-term clinic effectiveness,complications,Karnofsky performance status(KPS)score,and factors associated with survival were compared between the two groups of patients.Results The effective rate was 21.43%in the MWA group and 56.25%in the combined group,P<0.05;The complication rate was 46.43%in the MWA group and 62.50%in the combined group,P>0.05;one month after treatment,the KPS score was lower than that before treatment in both groups(P<0.05).Three months after treatment,the KPS score in the combined group was higher than that before treatment in this group,and much higher than the MWA group scores in the same period(P<0.05).The factors associated with survival were subjected to Cox regression,in which the protective factors were treatment modality[hazard ratio(HR)=0.400,95%confidence interval(CI)0.849~0.957,P=0.048]and preoperative KPS(HR=0.902,95%CI 0.850~0.957,P=0.001).Conclusions CT-guided MWA combined with ^(125)I seed implantation is safe and effective in the treatment of advanced and metastatic lung cancer,and the recent clinical effect is satisfactory.