目的 探讨CT引导下经皮穿刺微波消融(MWA)和胸腔镜手术治疗无法行手术的老年早期非小细胞肺癌(NSCLC)患者的临床疗效及安全性,并分析影响预后的危险因素. 方法 201 6年8月至2018年12月在北京医院接受MWA治疗的51例早期(Ⅰ期和ⅡA期)NSCLC患者(MWA组),选择同期年龄、性别等基本情况相似的50例接受胸腔镜手术治疗的早期NSCLC患者为对照组.回顾性分析比较两组患者的临床疗效和安全性,Kaplan Meier生存分析评价两组的生存率和局部无复发生存率,COX回归比例风险模型评估影响预后的危险因素. 结果 101例早期NSCLC患者中,男性62例(61.4％),年龄60～85岁,平均(72.3±11.6)岁.与对照组患者比较,MWA组患者年龄、性别、吸烟史、既往病史、肺功能、肿瘤直径、肿瘤病理、肿瘤位置、临床分期等差异均无统计学意义(P＞0.05).围术期MWA组无严重并发症,14例(27.5％)患者术后出现少量气胸,未行特殊处理后自行吸收,5例(9.8％)患者术后出现少量咯血,7例(13.7％)术后出现少量胸腔积液,9例(17.6％)术后出现低热(＜38.5℃),9例(17.6％)术后出现轻度疼痛.对照组围术期未见严重并发症.随访时间截止到2018年12月31日,中位随访时间为11.7个月(4.5～20.3个月).随访中期间无肿瘤相关死亡.10例(9.9％)出现局部复发,其中MWA组患者7例(13.7％),对照组患者3例(6.0％).MWA组和对照组的1年的总生存率[92.2％(47例)比96.0％(48例),P=0.313]、肿瘤特异性生存率(100.0％比100.0％,P=1.00)和局部无复发生存率[86.3％(44例)比94.0％(47例),P=0.156]比较差异无统计学意义.多因素COX回归分析结果显示,年龄(HR=1.22,95％CI:1.06～1.38,P=0.004)、肿瘤直径(HR=1.75,95％CI:1.14～2.36,P=0.005)和肿瘤临床分期(HR =1.53,95％CI:1.17～1.89,P=0.001)是影响局部无复发生存率的危险因素. 结论 MWA是治疗老年不适合手术治疗的早期肺癌患者有效、安全的治疗方法,年龄、肿瘤直径和临床分期是影响1年局部无复发生存率的危险因素.%Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA)in elderly patients with early-stage lung cancer who were unable to underwent surgery,and to evaluate the risk factors for prognosis.Methods A total of 51 patients with early stage(stages Ⅰ and ⅡA)non-small cell lung cancer (NSCLC)who underwent MWA in Beijing hospital from January 2016 to December 2018 were collected as the MWA group.And 50 patients with similar age and gender receiving lobectomy surgery were collected as the control group.In a retrospective follow-up study,the clinical efficacy and safety of treatment were compared between the study(n=51)and control(n=50)groups.Kaplan-Meier survival analysis was used to assess the overall survival and local recurrence-free survival.COX analysis was used to evaluate the risk factors.Results Of the 101 patients,62 were male(61.4％),aged 60-85 years(average,72.3± 11.6 years).There was no significant difference in baseline characteristics,including age,gender,smoking,medical history,lung function,tumor size,pathological type and histological grading,tumor position and clinical stage between the two groups(P＞0.05).There were no serious complications in the MWA group during perioperative period,and 14 cases (27.5％)had a small amount of pneumothorax after operation,which were absorbed after special treatment.Five cases (9.8％)had a small amount of hemoptysis,7 cases(13.7％)had a small amount of pleural effusion,9 cases(17.6％)had low fever (＜ 38.5 ℃),and 9 cases (17.6 ％) had postoperative mild pain.There were no serious complications in the control group.The follow-up period was up to December 31,2018,and the median follow-up time was 11.7 months(4.5 20.3 months).During the follow-up,local recurrence occurred in 10 patients(9.9％),including 7 patients(13.7％)in the MWA group and 3 patients(6.0％)in the control group.There was no significant difference between the MWA group and the control group in the 1-year overall survival rate(92.2％ or 47 cases vs.96.0％ or 48 cases,P =0.313),tumor-specific survivalrate(100.0％ vs.100.0％,P=1.00),local recurrence free survival rate(86.3％ or 44 cases vs.94.0％ or 47 cases,P =0.156).Multivariate COX regression analysis showed age (HR =1.22,95 ％CI:1.06-1.38,P =0.004),tumor size (HR =1.75,95 ％ CI:1.14-2.36,P =0.005) and clinical stage of tumor(HR =1.53,95 ％ CI:1.17-1.89,P =0.001) were risk factors for the local recurrencefree survival.Conclusions MWA is an effective and safe treatment for elderly patients with early-stage lung cancer who are not suitable for surgery.Age,tumor diameter and clinical stage are risk factors for local recurrence-free survival.
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