ABSTRACT
Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA)in elderly patients with early-stage lung cancer who were unable to underwent surgery,and to evaluate the risk factors for prognosis.Methods A total of 51 patients with early stage(stages Ⅰ and ⅡA)non-small cell lung cancer (NSCLC)who underwent MWA in Beijing hospital from January 2016 to December 2018 were collected as the MWA group.And 50 patients with similar age and gender receiving lobectomy surgery were collected as the control group.In a retrospective follow-up study,the clinical efficacy and safety of treatment were compared between the study(n=51)and control(n=50)groups.Kaplan-Meier survival analysis was used to assess the overall survival and local recurrence-free survival.COX analysis was used to evaluate the risk factors.Results Of the 101 patients,62 were male(61.4％),aged 60-85 years(average,72.3± 11.6 years).There was no significant difference in baseline characteristics,including age,gender,smoking,medical history,lung function,tumor size,pathological type and histological grading,tumor position and clinical stage between the two groups(P＞0.05).There were no serious complications in the MWA group during perioperative period,and 14 cases (27.5％)had a small amount of pneumothorax after operation,which were absorbed after special treatment.Five cases (9.8％)had a small amount of hemoptysis,7 cases(13.7％)had a small amount of pleural effusion,9 cases(17.6％)had low fever (＜ 38.5 ℃),and 9 cases (17.6 ％) had postoperative mild pain.There were no serious complications in the control group.The follow-up period was up to December 31,2018,and the median follow-up time was 11.7 months(4.5 20.3 months).During the follow-up,local recurrence occurred in 10 patients(9.9％),including 7 patients(13.7％)in the MWA group and 3 patients(6.0％)in the control group.There was no significant difference between the MWA group and the control group in the 1-year overall survival rate(92.2％ or 47 cases vs.96.0％ or 48 cases,P =0.313),tumor-specific survivalrate(100.0％ vs.100.0％,P=1.00),local recurrence free survival rate(86.3％ or 44 cases vs.94.0％ or 47 cases,P =0.156).Multivariate COX regression analysis showed age (HR =1.22,95 ％CI:1.06-1.38,P =0.004),tumor size (HR =1.75,95 ％ CI:1.14-2.36,P =0.005) and clinical stage of tumor(HR =1.53,95 ％ CI:1.17-1.89,P =0.001) were risk factors for the local recurrencefree survival.Conclusions MWA is an effective and safe treatment for elderly patients with early-stage lung cancer who are not suitable for surgery.Age,tumor diameter and clinical stage are risk factors for local recurrence-free survival.
ABSTRACT
Objective To investigate the clinical characteristics,prognosis,and influencing factors of digestive system tumors in elderly patients complicated with acute pulmonary thromboembolism(PTE).Methods In this retrospective cohort study,we analyzed data from 86 elderly patients with digestive system tumors from the Oncology Department of Beijing Hospital from January 2007 to January 2017.Forty-one elderly patients who had digestive system tumors with PTE were assigned into an observation group and forty five without PTE into a control group.We analyzed the clinical characteristics of the two groups.Kaplan-Meier survival analysis was used to assess the median survival time;and Cox regression analysis was used to evaluate the influencing factors for prognosis.Results Eighty-six elderly patients with a mean age of(75.8 ± 13.7)years ranging from 60 to 92 years were enrolled.There was a statistically significant difference in the D-dimer level between the groups at baseline (P ＜ 0.05).In the observation group,the primary symptom was dyspnea(78.0％,n=67).Of all primary tumors complicated with PTE,colorectal cancers had the highest prevalence,accounting for 56.1％ (n =23),followed by gastric cancers,representing 31.7％ (n=13).Twenty-three patients in the observation group were complicated with deep venous thrombosis(56.1％,n-23),which mostly located in the lower limbs (56.5 ％,n =23).Meanwhile,90.2 ％ of PTE(n =37) occurred during chemotherapy or follow-up.Sixty-seven patients (77.9 ％) died during the follow-up,and the difference in mortality between the two groups was statistically significant(P ＜ 0.05).Kaplan Meier survival analysis showed a significant difference in median survival time between the two groups (3.7 vs.8.5 months,P ＜ 0.05).Cox regression analysis indicated that age,PTE,and metastasis were risk factors for median survival time(all P ＜0.05) Conclusions Elderly patients with digestive system tumors complicated with acute pulmonary thromboembolism show no typical characteristics and poor prognosis.Therefore,preventive measures and care should be taken to improve the prognosis,especially for patients at high risk of PTE.