Department of Thoracic Surgery, Western Hospital, Footscray, Melbourne, VIC, 3011, Australia.
Department of Surgery, Peninsula Health, Frankston, VIC, 3199, Australia.
Cardiovasc Intervent Radiol. 2022 Aug;45(8):1102-1113. doi: 10.1007/s00270-022-03116-z. Epub 2022 Mar 30.
Pulmonary metastasectomy has been widely adopted in the treatment of metastatic disease. In recent years image guided ablation has seen increased use in the treatment of thoracic malignancies. The objective of this study was to evaluate oncological outcomes following percutaneous ablation (PA) of pulmonary metastasis.
A comprehensive search of the PubMed, MEDLINE and EMBASE databases from January 2000 to August 2021 was performed to identify studies evaluating patient survival following ablation of lung metastasis. Pooled outcomes have been presented with a random effects model to assess primary outcomes of overall survival, progression free survival and 1-year local control. Secondary outcomes included procedural mortality, major complications, and the incidence of pneumothorax.
A total of 24 studies were identified. The pooled median overall survival was 5.13 [95% confidence interval (CI): 4.37-6.84] years, and the 1-, 3-, 5-year progression free survival rates were 53%, 26% and 20% respectively. The 1-year local control rate was 91% (95%CI: 86-95%). Periprocedural mortality was rare (0%; 95%CI: 0-1%), as were major complications excluding pneumothorax (1%; 95%CI: 1-2%). Pneumothorax developed in 44% of ablation sessions, although only half of these required chest tube placement. Most patients were able to be discharged day one post-procedurally.
PA demonstrates high overall, progression free and local tumour survival in patients with lung metastasis. Complications and mortality are also rare. Consideration of its use should be made in a tumour board meeting in conjunction with surgical and radiotherapy perspectives for targeted local control of metastases.
肺转移瘤切除术已广泛应用于转移性疾病的治疗。近年来，影像引导消融术在治疗胸部恶性肿瘤方面的应用日益增多。本研究旨在评估经皮消融（PA）治疗肺转移瘤的肿瘤学疗效。
对 2000 年 1 月至 2021 年 8 月期间 PubMed、MEDLINE 和 EMBASE 数据库进行全面检索，以确定评估消融治疗肺转移瘤后患者生存情况的研究。采用随机效应模型汇总主要结局指标，包括总生存率、无进展生存率和 1 年局部控制率。次要结局指标包括手术死亡率、主要并发症发生率和气胸发生率。
共纳入 24 项研究。荟萃分析显示，中位总生存期为 5.13 年[95%置信区间（CI）：4.37-6.84]，1、3、5 年无进展生存率分别为 53%、26%和 20%。1 年局部控制率为 91%（95%CI：86-95%）。围手术期死亡率较低（0%；95%CI：0-1%），气胸发生率较低（44%；95%CI：36-52%）。但其中一半患者需要放置胸腔引流管。大多数患者术后第一天即可出院。
PA 治疗肺转移瘤患者的总生存率、无进展生存率和局部肿瘤生存率较高，并发症和死亡率较低。在肿瘤委员会会议上，应结合手术和放疗观点，考虑使用 PA 来靶向控制转移瘤。
