Pulmonary radiofrequency ablation: Long-term safety and efficacy in 153 patients
Pulmonary radiofrequency ablation: Long-term safety and efficacy in 153 patients
复制标题
DOI：
10.1148/radiol.2431060088
复制
发表时间：
2007-04-01
期刊：
影响因子：
19.7
通讯作者：
Mayo-Smith, William W.
中科院分区：
文献类型：
--
作者：
Simon, Caroline J.;Dupuy, Damian E.;Mayo-Smith, William W.
目的：回顾性评价在三级肿瘤医院接受拒绝或不适合手术的经皮计算机断层扫描（CT）引导的肺肿瘤射频消融的患者的长期生存率、局部肿瘤进展和并发症发生率。材料和方法：本研究符合hipaa标准，经机构审查委员会批准；知情同意被放弃。1998年至2005年间，153例189例原发或转移性医学上不能手术的肺癌患者（平均年龄68.5岁，范围17 - 94岁）接受了经皮透视ct引导下的射频消融术。临床结果是根据对医疗记录、影像学随访报告和任何活检证实的残留或复发疾病（如有）的审查编制的。Kaplan-Meier方法用于估计总生存期和无病生存期（进展）作为射频消融后时间的函数。生存函数间比较采用log-rank统计；P < 0.05为差异有统计学意义。结果：I期非小细胞肺癌的1、2、3、4和5年生存率分别为78%、57%、36%、27%和27%；结直肠肺转移率分别为87%、78%、57%、57%和57%。1年、2年、3年、4年和5年的局部肿瘤无进展率，对于小于或等于3cm的肿瘤分别为83%、64%、57%、47%和47%，对于大于3cm的肿瘤分别为45%、25%、25%、25%和25%。大（> 3cm）和小（> 3cm）肿瘤的生存曲线差异有统计学意义（P < 0.002）。总体气胸发生率为28.4%（183例消融中52例），胸管插入率为9.8%（183例消融中18例）。总体30天死亡率为3.9%（153例患者中的6例），手术特异性30天死亡率为2.6%（153例患者中的4例）。结论：肺射频消融似乎是安全的，并且与有希望的长期生存和局部肿瘤进展结果相关，特别是考虑到接受治疗的患者群体。
Purpose: To retrospectively evaluate long-term survival, local tumor progression, and complication rates for all percutaneous computed tomographic (CT)-guided lung tumor radiofrequency (RF) ablations performed at a tertiary care cancer hospital in patients who refused or who were not candidates for surgery.Materials and Methods: This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Between 1998 and 2005, 153 consecutive patients (mean age, 68.5 years; range, 17 - 94 years) with 189 primary or metastatic medically inoperable lung cancers underwent percutaneous fluoroscopic CT-guided RF ablation. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease (when available). Kaplan-Meier method was used to estimate overall survival and disease-free survival (progression) as a function of time since RF ablation. Comparisons between survival functions were performed by using the log-rank statistic; P < .05 was considered to indicate a significant difference.Results: The overall 1-, 2-, 3-, 4-, and 5-year survival rates, respectively, for stage I non - small cell lung cancer were 78%, 57%, 36%, 27%, and 27%; rates for colorectal pulmonary metastasis were 87%, 78%, 57%, 57%, and 57%. The 1-, 2-, 3-, 4-, and 5- year local tumor progression - free rates, respectively, were 83%, 64%, 57%, 47%, and 47% for tumors 3 cm or smaller and 45%, 25%, 25%, 25%, and 25% for tumors larger than 3 cm. The difference between the survival curves associated with large (> 3 cm) and small (> 3 cm) tumors was significant (P < .002). The overall pneumothorax rate was 28.4% (52 of 183 ablation sessions), with a 9.8% (18 of 183 ablation sessions) chest tube insertion rate. The overall 30-day mortality rate was 3.9% (six of 153 patients), with a 2.6% (four of 153 patients) procedure-specific 30-day mortality rate.Conclusion: Lung RF ablation appears to be safe and linked with promising long-term survival and local tumor progression outcomes, especially given the patient population treated.