A retrospective study of microwave ablation and thoracoscopic surgery for multiple primary lung cancer: a propensity score matching analysis.

IF 1.6 4区医学 Q2 SURGERY Frontiers in Surgery Pub Date : 2025-03-11 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1547048

Bangsheng Li, Shengguai Gao, Jie Mao, Zhenghong Yang, Ying Chen, Xi Wang, Yunchao Huang

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Abstract

Purpose: Microwave ablation (MWA) is a minimally invasive local treatment with demonstrated safety and efficacy, but its role in managing multiple primary lung cancer (MPLC) is not well-established. This study retrospectively evaluates the clinical effectiveness of MWA compared to video-assisted thoracoscopic surgery (VATS) in treating MPLC.

Materials and methods: A retrospective analysis was conducted using data from patients with non-small cell lung cancer (NSCLC) treated at Peking University Cancer Hospital Yunnan Hospital between January 2021 and April 2024. All patients had undergone surgical resection for their first primary lung cancer (FPLC) and subsequently received either MWA or VATS for second primary lung cancer (SPLC). After 1:1 propensity score matching (PSM), 202 patients per group were included. Study endpoints included progression-free survival (PFS), overall survival (OS), complications, and pulmonary function changes.

Results: Median follow-up was 24.47 months. Survival analysis revealed a statistically significant difference in PFS between MWA and VATS groups (HR = 2.74, 95% CI: 1.40-5.36, p = 0.006), while OS showed no difference (HR = 1.41, 95% CI: 0.45-4.36, p = 0.56). The incidence of grade ≥ II complications was significantly lower in the MWA group (p < 0.001). Pulmonary function tests indicated no significant changes in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1%, maximal voluntary ventilation (MVV), and diffusion capacity of the lung for carbon monoxide%(DLCO%) before and 1-3 month post MWA (p > 0.05).

Conclusions: In MPLC patients with stage IA SPLC, VATS demonstrates a greater clinical efficacy advantage in terms of local tumor control compared to MWA. Additionally, MWA provided significant advantages in reducing complication severity and preserving pulmonary function. These findings suggest that the therapeutic approach combining surgery with MWA represents a safe and effective option for MPLC.

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微波消融和胸腔镜手术治疗多发性原发性肺癌的回顾性研究：倾向评分匹配分析。

目的：微波消融（MWA）是一种安全有效的微创局部治疗方法，但其在多发性原发性肺癌（MPLC）治疗中的作用尚不明确。本研究回顾性评价MWA与视频胸腔镜手术（VATS）治疗MPLC的临床效果。材料与方法：回顾性分析北京大学肿瘤医院云南医院2021年1月至2024年4月收治的非小细胞肺癌（NSCLC）患者资料。所有患者均因其第一原发性肺癌（FPLC）接受手术切除，随后因其第二原发性肺癌（SPLC）接受MWA或VATS。经1:1倾向评分匹配（PSM）后，每组纳入202例患者。研究终点包括无进展生存期（PFS）、总生存期（OS）、并发症和肺功能改变。结果：中位随访时间为24.47个月。生存分析显示MWA组与VATS组PFS差异有统计学意义（HR = 2.74, 95% CI: 1.40 ~ 5.36, p = 0.006）， OS差异无统计学意义（HR = 1.41, 95% CI: 0.45 ~ 4.36, p = 0.56）。MWA组≥II级并发症发生率明显低于MWA组（p < 0.05）。结论：在MPLC合并IA期SPLC患者中，与MWA相比，VATS在局部肿瘤控制方面具有更大的临床疗效优势。此外，MWA在降低并发症严重程度和保留肺功能方面具有显著优势。这些研究结果表明，手术联合MWA治疗MPLC是一种安全有效的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.