Zhong Guoqing, Zeng Longhui, He Yue, Zeng Xiaolong, Huang Wenhan, Yang Tao, Chu Xiao, Xiao Jin, Yin Dong, Chang Yunbing, Cheng Shi, Zhang Yu
Department of Orthopaedic Oncology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Shantou University Medical College, Shantou, China.
Orthop Surg. 2022 Jul;14(7):1300-1308. doi: 10.1111/os.13236. Epub 2022 May 23.
To investigate the clinical effects of microwave ablation (MWA) in addition to open surgery for the treatment of lung cancer-derived thoracolumbar metastases.
This was a single-institution, retrospective, cohort study. From January 2019 to December 2020, a total of 47 patients with lung cancer-derived thoracolumbar metastases underwent posterior spinal canal decompression and fixation surgery in our hospital. Two independent surgical teams treated these patients. One group underwent open surgery combined with MWA therapy, while the other had open surgery only (control). The pre- and post-operative visual analog scale (VAS) scores and the overall survival (OS) were compared between the MWA and control groups. The Frankel Grade classification was applied for the evaluation of the post-surgical spinal cord function. Improvement was defined as an increase of at least one rank from the pre-operative scores. Each patient was evaluated pre- and post-operatively at 48 h, 1 month, and 3-month intervals. Data on surgical-related complications were recorded.
Thirty men and 17 women were included, with an average age of 57.9 ± 11.4 years (range, 26-81 years). Twenty-eight patients underwent MWA and were in the MWA group, and 19 patients were included in the control group. Post-operatively all patients were followed up regularly; the median follow-up time was 12 months (range, 3-24 months), and their median OS was 14 months. Patients in the MWA group had a lower VAS score than those in the control group at the 48-h (1.75 ± 1.01 vs 2.47 ± 0.96, P = 0.01) and 1-month (1.79 ± 0.92 vs 2.53 ± 1.35, P = 0.048) check-ups. At the 3-month evaluation, the VAS score differences between the two groups were not significant (P = 0.133). After surgery, spinal cord function improvement was not significantly different between the MWA and control groups (P = 0.515). MWA therapy combined with open surgery was not associated with increased OS compared with the control group (P = 0.492).
MWA can be an effective and safe pain-relief method but may not extend the OS of patients with lung cancer.
探讨微波消融（MWA）联合开放手术治疗肺癌所致胸腰椎转移瘤的临床效果。
这是一项单机构回顾性队列研究。2019年1月至2020年12月，我院共有47例肺癌所致胸腰椎转移瘤患者接受了后路椎管减压及内固定手术。由两个独立的手术团队治疗这些患者。一组接受开放手术联合MWA治疗，另一组仅接受开放手术（对照组）。比较MWA组和对照组术前和术后视觉模拟量表（VAS）评分及总生存期（OS）。采用Frankel分级对术后脊髓功能进行评估。改善定义为较术前评分至少提高一个等级。每位患者在术前及术后48小时、1个月和3个月进行评估。记录手术相关并发症的数据。
纳入30例男性和17例女性，平均年龄57.9±11.4岁（范围26 - 81岁）。28例患者接受MWA治疗，为MWA组，19例患者纳入对照组。术后所有患者均定期随访；中位随访时间为12个月（范围3 - 24个月），中位OS为14个月。在48小时（1.75±1.01 vs 2.47±0.96，P = 0.01）和1个月（1.79±0.92 vs 2.53±1.35，P = 0.048）检查时，MWA组患者的VAS评分低于对照组。在3个月评估时，两组间VAS评分差异无统计学意义（P = 0.133）。术后，MWA组和对照组脊髓功能改善情况无显著差异（P = 0.515）。与对照组相比，MWA治疗联合开放手术并未延长患者的OS（P = 0.492）。
MWA可能是一种有效且安全的止痛方法，但可能不会延长肺癌患者的OS。
