Abstract
ObjectiveTo assess the ablative margin of microwave ablation (MWA) for stage I non-small cell lung cancer (NSCLC) using a three-dimensional (3D) reconstruction technique.Materials and methodsWe retrospectively analyzed 36 patients with stage I NSCLC lesions undergoing MWA and analyzed the relationship between minimal ablative margin and the local tumor progression (LTP) interval, the distant metastasis interval and disease-free survival (DFS). The minimal ablative margin was measured using the fusion of 3D computed tomography reconstruction technique.ResultsUnivariate and multivariate analyses indicated that tumor size (hazard ratio [HR] = 1.91, P < 0.01; HR = 2.41, P = 0.01) and minimal ablative margin (HR = 0.13, P < 0.01; HR = 0.11, P < 0.01) were independent prognostic factors for the LTP interval. Tumor size (HR = 1.96, P < 0.01; HR = 2.35, P < 0.01) and minimal ablative margin (HR = 0.17, P < 0.01; HR = 0.13, P < 0.01) were independent prognostic factors for DFS by univariate and multivariate analyses. In the group with a minimal ablative margin < 5 mm, the 1-year and 2-year local progression-free rates were 35.7% and 15.9%, respectively. The 1-year and 2-year distant metastasis-free rates were 75.6% and 75.6%, respectively; the 1-year and 2-year disease-free survival rates were 16.7% and 11.1%, respectively. In the group with a minimal ablative margin ≥ 5 mm, the 1-year and 2-year local progression-free rates were 88.9% and 69.4%, respectively. The 1-year and 2-year distant metastasis-free rates were 94.4% and 86.6%, respectively; the 1-year and 2-year disease-free survival rates were 88.9% and 63.7%, respectively. The feasibility of 3D quantitative analysis of the ablative margins after MWA for NSCLC has been validated.ConclusionsThe minimal ablative margin is an independent factor of NSCLC relapse after MWA, and the fusion of 3D reconstruction technique can feasibly assess the minimal ablative margin.
Highlights
Worldwide, lung cancer has the highest incidence and mortality of all cancers, with 2.1 million new lung cancer cases and 1.8 million deaths in 2018 [1]
Baseline characteristics From January 2015 to October 2018, a total of 36 patients with stage I non-small cell lung cancer (NSCLC) were enrolled based on the inclusion and exclusion criteria
Adenocarcinoma was pathologically diagnosed in 27 patients
Summary
Lung cancer has the highest incidence and mortality of all cancers, with 2.1 million new lung cancer cases and 1.8 million deaths in 2018 [1]. Lung cancer has been divided into two main histological types: small cell lung cancer (SCLC) accounts for 15–25% of all lung cancer cases, and non-small cell lung cancer (NSCLC). Yan et al BMC Med Imaging (2021) 21:96 accounts for approximately the remaining 75–85% [2]. As low-dose CT screening has become more widespread, more early-stage lung cancers have been screened [3]. Surgical resection remains the cornerstone of therapy for stage I NSCLC. Lobectomy with hilar and mediastinal lymphadenectomy is the standard surgical treatment for stage I NSCLC. Approximately 20% of patients with early-stage NSCLC are unable to tolerate surgery because of compromised cardiopulmonary functions or other comorbidities [4]
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