Abstract
ObjectiveThe present study has compared the long-term outcomes between performing wedge resection (WR) and microwave ablation (MWA) as first-line treatment of stage I non–small cell lung cancer (NSCLC) patients with tumors adjacent to the pericardium.Materials and MethodsBetween January 2014 and December 2018, a total of 223 consecutive patients with T1N0 NSCLC underwent first-line treatment by WR (n = 155) or image-guided lung MWA (n = 68). This study has compared the progression-free survival (PFS) and overall survival (OS) rates between the two treatments before and after propensity score matching. Subgroup analysis of these outcomes was conducted based on the distance from the pericardium.ResultsThe median follow-up time was 47 months. Propensity matching yielded 56 pairs of patients. In the two matched groups, the PFS rates in the WR group at 3 and 5 years were 66.0% and 56.0% and 54.0% and 36.0%, respectively, in the MWA group (P = 0.029). Meanwhile, the corresponding OS rates for the WR group at 3 and 5 years were 81.0% and 72.0% and 60.0% and 55.0% in the MWA group, respectively (P = 0.031). Subgroup analysis, done according to the treatment modality, indicated that local tumor recurrence and PFS for NSCLCs that were close but not contiguous to the pericardium were different from those contiguous to the pericardium (P = 0.018 and P = 0.025, respectively).ConclusionWR provided better long-term tumor control and OS compared to MWA for stage I NSCLC adjacent to the pericardium as a first-line treatment. MWA can be considered as an alternative option for high-risk and inoperable patients, particularly for tumors that were not contiguous to the pericardium.
Highlights
Lung cancer accounts for the highest number of cancerrelated deaths globally [1]
wedge resection (WR) provided better long-term tumor control and overall survival (OS) compared to microwave ablation (MWA) for stage I non–small cell lung cancer (NSCLC) adjacent to the pericardium as a first-line treatment
We included patients with biopsyproven stage I NSCLC adjacent to the pericardium (n = 68), and these were treated by computed tomography (CT)-guided MWA
Summary
Lung cancer accounts for the highest number of cancerrelated deaths globally [1]. Anatomic lung resection represents the standard curative therapy for patients with early-stage non–small cell lung cancer (NSCLC). Approximately 30% of patients are not eligible for surgery because of various reasons, including detection at an advanced-stage, medical comorbidities, insufficient cardiopulmonary function, or poor performance scores [2]. One minimal invasive therapy is percutaneous microwave ablation (MWA), which has emerged as the preferred therapeutic strategy for patients who are not to undergo operation [3, 4]. MWA is minimally invasive, as it only causes mild deleterious effects on pulmonary function, needs a short reconvalescence, and allows for repeated procedures [5].
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