文章摘要

射频消融术治疗老年早期非小细胞肺癌的疗效

作者: 1何灵慧, 2黄灿红, 3丁勇生
1 南通市肿瘤医院内科，江苏 南通 226000
2 南通市肿瘤医院放疗科，江苏 南通 226000
3 南通市肿瘤医院影像科，江苏 南通 226000
通讯: 丁勇生 Email: 393950116@qq.com
DOI: 10.3978/j.issn.2095-6959.2022.11.013

摘要

目的：探讨射频消融术(radiofrequency ablation，RFA)治疗老年早期非小细胞肺癌(non-small cell lung cancer，NSCLC)的疗效。方法：纳入于2018年1月至2022年1月南通市肿瘤医院就诊的64例≥60岁的Ia期(T1N0M0)NSCLC患者作为研究对象，其中接受RFA治疗的患者为RFA组(n=34)，接受立体定向放射治疗(stereotactic body radiation therapy，SBRT)的患者为SBRT组(n=30)。经治疗后，分析并比较两组患者的疗效、并发症发生情况及预后。结果：RFA组患者经第1次RFA治疗后，完全消融率为91.18%(31/34)，部分消融率为8.82%(3/34)，消融效果较好。术后6个月评价两组患者的短期疗效，结果显示：RFA组客观缓解率(objective response rate，ORR)为82.35%，疾病控制率(disease control rate，DCR)为91.18%；SBRT组ORR为83.33%，DCR为91.18%；两组相比差异无统计学意义(P>0.05)。RFA组的1、2、3年的复发率略高于SBRT组，但组间比较差异均无统计学意义(8.82% vs 6.67%，14.71% vs 13.33%，25.53% vs 23.33%，均P>0.05)。RFA组PFS为(34.68±0.60)个月，95%CI：33.51~35.83；SBRT组PFS为(31.69±1.23)个月，95%CI：29.88~34.10；RFA组PFS显著长于SBRT组(P=0.047)。两组患者并发症的发生情况差异无统计学意义(P>0.05)。Logistic分析结果显示：肿瘤直径为影响并发症发生的独立危险因素(P<0.05)，肿瘤直径较大的患者发生并发症的风险为肿瘤直径较小患者的7.437倍。结论：RFA治疗早期NSCLC的老年患者可取得较好疗效，与目前临床常用的SBRT相似，且安全性较高，但也可能会发生气胸等并发症。临床医生需要结合患者的肿瘤直径谨慎选择治疗方案。
关键词： 射频消融术；非小细胞肺癌；生存分析；并发症

Efficacy of radiofrequency ablation on senile patients with early-stage non-small cell lung cancer

Authors: 1HE Linghui, 2HUANG Canhong, 3DING Yongsheng
1 Department of Medical, Nantong Cancer Hospital, Nantong Jiangsu 226000, China
2 Department of Radiotherapy, Nantong Cancer Hospital, Nantong Jiangsu 226000, China
3 Department of Imaging, Nantong Cancer Hospital, Nantong Jiangsu 226000, China

CorrespondingAuthor: DING Yongsheng Email: 393950116@qq.com

DOI: 10.3978/j.issn.2095-6959.2022.11.013

Abstract

Objective: To explore the efficacy of radiofrequency ablation (RFA) in the treatment of elderly patients with early-stage non-small cell lung cancer (NSCLC). Methods: A total of 64 patients ≥60 years old patients with stage Ia (T1N0M0) NSCLC who visited Nantong Cancer Hospital from January 2018 to January 2022 were enrolled as research subjects. Among them, the patients who received RFA treatment were selected as a RFA group (n=34), and the patients who received stereotactic body radiation therapy (SBRT) were selected as a SBRT group (n=30). After the treatment, the curative effect, complications, and prognosis between the 2 groups were analyzed and compared. Results: After the first RFA treatment, the complete ablation rate and partial ablation rate of RFA group were 91.18% (31/34) and 8.82% (3/34), respectively. The ablation effect was good. Six months after the operation, the short-term efficacy between the 2 groups was evaluated. The results showed that the objective response rate (ORR) and disease control rate (DCR) of the RFA group were 82.35% and 91.18%, respectively. The ORR and DCR of SBRT group were 83.33% and 91.18%, respectively. There was no significant difference between the 2 groups (P>0.05). The 1-, 2-, and 3-year recurrence rates in the RFA group were slightly higher than those in the SBRT group, but there was no significant difference between the 2 groups (8.82% vs 6.67%, 14.71% vs 13.33%, 25.53% vs 23.33%, all P>0.05). The PFS of RFA group was (34.68±0.60) months, 95%CI 33.51 to 35.83. PFS of SBRT group was (31.69±1.23) months, 95%CI 29.88 to 34.10. PFS of RFA group was significantly longer than that of SBRT group (P=0.047). There was no significant difference in the incidence of complications between the 2 groups (P>0.05). The results of logistic analysis showed that tumor diameter was an independent risk factor affecting the occurrence of complications (P<0.05), and the risk of complications in patients with larger tumor diameter was 7.437 times that in patients with smaller tumor diameter. Conclusion: The efficacy of RFA in the treatment of elderly patients with early-stage NSCLC is similar to that of currently commonly used SBRT. RFA treatment can achieve good efficacy and high safety, but complications such as pneumothorax may also occur. Therefore, clinicians need to carefully select treatment options based on the patient's tumor diameter.

Keywords： radiofrequency ablation; non-small cell lung cancer; survival analysis; complications

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