Yang Qiuxia, Qi Han, Zhang Rong, Wan Chao, Song Ze, Zhang Liang, Fan Weijun
Department of Medical Imaging Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China.
Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China.
J Vasc Interv Radiol. 2017 Apr;28(4):481-489. doi: 10.1016/j.jvir.2016.11.042. Epub 2017 Jan 19.
To retrospectively evaluate risk factors related to incomplete computed tomography (CT)-guided radiofrequency (RF) ablation of metastatic and primary lung tumors.
This study included 93 patients with 147 tumors: 70 men, 23 women; median age 54 y (range, 19-81 y); 24 cases of primary lung tumors, 69 cases of metastases; average largest diameter of tumors, 1.8 cm ± 1.2 (range, 0.3-6.0 cm). Local efficacy was evaluated based on CT follow-up scans. Complete ablation rates (CARs) for tumors were calculated according to several variables; independent risk factors for local tumor progression (LTP) were examined by binary logistic regression analysis.
CAR of tumors was 60.54% within first 6 months after lung RF ablation; median interval of LTP was 1.5 months (mean, 1.3 months ± 1.0; range, 0 days to 3 months). Compared with tumors > 3 cm, CAR of tumors ≤ 3 cm was significantly higher (68.55% vs 17.39%, P < .001). CAR of tumors with complete ablation margin (AM) was dramatically higher compared with tumors with incomplete AM (74.77% vs 16.67%, P < .001). Among tumors with complete AM, CAR of tumors with shortest distance between outer edge of tumor and AM (ablative margin D) ≥ 5 mm was compared with tumors with ablative margin D 1-4 mm (85.96% vs 62.96%, P = .005). Multivariate regression analysis showed that lobulation and/or spicules, contact with blood vessels, and ablative margin D < 5 mm were independent risk factors for incomplete lung RF ablation. LTP was likely to develop at the edge of ablated lesions and especially the site of incomplete AM or shortest AM.
RF ablation for lung cancers should be individualized based on tumor size, morphology, and tumor type to obtain an adequate AM.
回顾性评估与转移性和原发性肺肿瘤的计算机断层扫描（CT）引导下射频（RF）消融不完全相关的危险因素。
本研究纳入93例患者的147个肿瘤：男性70例，女性23例；中位年龄54岁（范围19 - 81岁）；原发性肺肿瘤24例，转移瘤69例；肿瘤平均最大直径1.8 cm±1.2（范围0.3 - 6.0 cm）。根据CT随访扫描评估局部疗效。根据多个变量计算肿瘤的完全消融率（CARs）；通过二元逻辑回归分析检查局部肿瘤进展（LTP）的独立危险因素。
肺RF消融后前6个月内肿瘤的CAR为60.54%；LTP的中位间隔时间为1.5个月（平均1.3个月±1.0；范围0天至3个月）。与直径>3 cm的肿瘤相比，直径≤3 cm的肿瘤的CAR显著更高（68.55%对17.39%，P<.001）。具有完全消融边缘（AM）的肿瘤的CAR与具有不完全AM的肿瘤相比显著更高（74.77%对16.67%，P<.001）。在具有完全AM的肿瘤中，将肿瘤外缘与AM之间最短距离（消融边缘D）≥5 mm的肿瘤的CAR与消融边缘D为1 - 4 mm的肿瘤进行比较（85.96%对62.96%，P = .005）。多变量回归分析显示，分叶和/或毛刺、与血管接触以及消融边缘D<5 mm是肺RF消融不完全的独立危险因素。LTP可能在消融病变的边缘尤其是不完全AM或最短AM的部位发生。
肺癌的RF消融应根据肿瘤大小、形态和肿瘤类型进行个体化，以获得足够的AM。
