Outcomes of First-line Microwave Ablation of Treatment-Naive Epidermal Growth Factor Receptor-Mutated Advanced Lung Adenocarcinoma Treated with Tyrosine Kinase Inhibitors.

PURPOSE: To investigate the outcomes of first-line image-guided microwave ablation (MWA) plus tyrosine kinase inhibitors (TKIs) in untreated epidermal growth factor receptor (EGFR)-mutant advanced lung adenocarcinoma (LUAD), and to compare with TKIs alone. MATERIALS AND METHODS: This retrospective cohort study included patients between December 2015 and December 2021, and was divided into two groups (group A: first-line MWA+TKIs; group B: TKIs alone). Progression-free survival (PFS) was the primary endpoint, whereas overall survival (OS) was the secondary endpoint, and were compared via the Kaplan-Meier methods. Univariate and multivariate analyses were used to investigate the predictors of PFS and OS. Propensity score matching (PSM; 1:1 ratio) was applied between group B and the subgroup of complete ablation in group A. RESULTS: A total of 117 patients were included (group A: n=43; group B: n=74). In a mean follow-up of 47.0±19.4 months, group A had significantly longer median PFS (19.0 vs. 10.0 months, P<0.001) and OS (41.0 vs. 25.0 months, P=0.044) than group B. Predictors of PFS included first-line MWA (P<0.001) and tumor stage (P=0.020), while that of OS included first-line MWA (P=0.039), tumor stage (P=0.014) and usage of third-generation TKIs (P=0.001). There were 23 pairs of patients obtained after PSM (group A1: complete ablation+TKIs; group B1: TKIs alone). Group A1 had significantly longer median PFS (24.0 vs. 10.0 months, P<0.001) and OS (48.0 vs. 24.0 months, P=0.012) than group B1. CONCLUSIONS: First-line MWA significantly improved the outcomes of patients with untreated EGFR-mutant advanced LUAD treated with TKIs. Complete ablation predicts a better prognosis.

Acute-phase plasma proteomics of rabbit lung VX2 tumors treated by image-guided microwave ablation.

Purpose: To explore the plasma proteomic changes of rabbit lung VX2 tumors treated by microwave ablation, and to explore the molecular pathway mechanisms that may be involved. Methods: New Zealand white rabbits were inoculated with VX2 tumor cell suspension in the right lower lung and treated with microwave ablation after 2-3 weeks of tumor formation. Blood was collected at 5 time points (TP1~TP5) before and after ablation by cardiac blood sampling and pre-treated before proteomic analysis. The plasma proteome was analyzed by Data-Independent Acquisition (DIA). Results: Different molecular pathways were activated at different time points:(i) TP1vsTP2: more proteins were down-regulated and enrichment analysis showed that the proteasome pathway was activated. The abnormal protein folding process involved in this pathway is closely related to the process of tumor development. (ii) TP2vsTP3: more proteins were up-regulated although the number of differentially differentiated proteins was lower and enrichment analysis showed that the phagosome pathway was activated. After microwave ablation inactivates tumor cells, it activates the phagosomal pathway for immune clearance of necrotic tumor tissue. (iii) TP3vsTP4: more down-regulated proteins, enrichment analysis showed that cysteine and methionine metabolism pathway was activated. Decreased metabolism of these amino acids suggests that cancer progression may be blocked after microwave ablation therapy. (iv) TP4vsTP5: the number of differential proteins was less and more down-regulated proteins, enrichment analysis showed that glutathione metabolism and metabolism of xenobiotics by cytochrome P450 pathway were activated. The down-regulated proteins in this pathway may suggest that microwave ablation may have reduced resistance to certain chemotherapeutic agents following. Conclusions: In the process of lung cancer treatment by microwave ablation, the changes of proteins on the possible molecular pathways at each time point are related to lung cancer, and not only involve some simple inflammatory reactions, and some of the proteins released by destroying the tumor cells can be used as possible drug binding sites and reduce drug resistance.

Maintenance treatment of immunotherapy after microwave ablation plus drug-eluting bead bronchial arterial chemoembolization for advanced non-small cell lung cancer: a retrospective single-center cohort study.

Background: The combination therapy of immunotherapy and drug-eluting bead bronchial artery chemoembolization (DEB-BACE) or microwave ablation (MWA) has been attempted as an effective and safe approach for advanced non-small cell lung cancer (NSCLC). However, the outcomes of immunotherapy plus multiple interventional techniques for advanced NSCLC remain unclear. This retrospective study thus aimed to investigate the effectiveness and safety of the maintenance treatment of programmed cell death protein 1 (PD-1) blockade after MWA plus DEB-BACE for advanced NSCLC. Methods: This retrospective cohort study consists of 95 patients with advanced NSCLC who were treated with DEB-BACE between April 2017 and October 2022 and who were allocated to three groups: group A (MWA + DEB-BACE + PD-1 blockade; n=15), group B (MWA + DEB-BACE; n=25), and group C (DEB-BACE alone; n=55). The adverse events (AEs) were compared between the three groups. The outcomes were compared via Kaplan-Meier methods, including median progression-free survival (PFS) and overall survival (OS). Survival analyses were performed via the univariate and multivariate analyses to investigate the prognostic predictors. Results: The overall incidence of AEs in the groups A-C was 53.3% (8/15), 36.0% (9/25), and 32.7% (18/55), respectively, which did not represent a significant difference (P=0.42). No severe AEs (SAEs) occurred. Group A, compared with group B and group C, had a significantly longer estimated median PFS (33.0 vs. 7.0 vs. 3.0 months; P<0.001) and OS (33.0 vs. 13.0 vs. 6.0 months; P=0.002). PD-1 blockade (P=0.006), tumor number (P=0.01), and DEB-BACE/bronchial artery infusion (BAI) chemotherapy cycles (P=0.04) were identified as the predictors of PFS, while the predictors of OS were PD-1 blockade (P<0.001), number of metastases (P<0.001), tumor diameter (P<0.001), and DEB-BACE/BAI cycles (P=0.02). Conclusions: Compared with that of advanced NSCLC treated with MWA plus DEB-BACE or DEB-BACE alone, the maintenance treatment of immunotherapy after MWA plus DEB-BACE might provide a superior prognosis without increasing the risk of AEs.

Percutaneous core-needle biopsy before and immediately after coaxial microwave ablation in solid non-small cell lung cancer: the comparison of genomic testing from specimens.

PURPOSE: To compare the genomic testing based on specimens obtained from percutaneous core-needle biopsy (CNB) before and immediately after coaxial microwave ablation (MWA) in solid non-small cell lung cancer (NSCLC), and to investigate the diagnostic performance of CNB immediately after coaxial MWA in solid NSCLC. METHODS: Coaxial MWA and CNB were performed for NSCLC patients, with a power of 30 or 40 watts (W) in MWA between the pre- and post-ablation CNB, followed by continuous ablation after the second CNB on demand. The paired specimens derived from the same patient were compared for pathological diagnosis and genomic testing. DNA/RNA extracted from the paired specimens were also compared. RESULTS: A total of 33 NSCLC patients with solid lesions were included. There were two patients (6.1%) without atypical cells and three patients (9.1%) who had the technical failure of genomic testing in post-ablation CNB. The concordance rate of pathological diagnosis between the twice CNB was 93.9% (kappa = 0.852), while that of genomic testing was 90.9% (kappa = 0.891). For the comparisons of DNA/RNA extracted from pre- and post-ablation CNB in 30 patients, no significant difference was found when the MWA between twice CNB has a power of 30 or 40 W and ablation time within five minutes (P = 0.174). CONCLUSIONS: If the pre-ablation CNB presented with a high risk of pneumothorax or hemorrhage, the post-ablation CNB could be performed to achieve accurate pathological diagnosis and genomic testing and the maximum effect of ablation, which might allow for the diagnosis of genomic testing in 90.9% of solid NSCLC.

Drug-eluting beads bronchial arterial chemoembolization/bronchial arterial infusion chemotherapy with and without PD-1 blockade for advanced non-small cell lung cancer: a comparative single-center cohort study.

Background: Drug-eluting beads bronchial arterial chemoembolization (DEB-BACE)/bronchial artery infusion chemotherapy (BAI) have been investigated as treatment options for advanced non-small cell lung cancer (NSCLC), especially for those patients who develop refractoriness to or are intolerant to systemic chemotherapy. This retrospective study aimed to compare the outcomes of DEB-BACE/BAI with and without programmed cell death protein 1 (PD-1) blockade for advanced NSCLC, and to investigate the effectiveness and safety of combination regimens. Methods: This retrospective cohort study included advanced NSCLC patients who were intolerant to or were resistant to systemic chemotherapy, radiotherapy, or molecular targeted therapy and underwent DEB-BACE/BAI between October 2016 and October 2021 in Beijing Hospital, National Center of Gerontology. A total of 84 advanced NSCLC patients (DEB-BACE/BAI + PD-1 blockade group: group A, n=27; DEB-BACE/BAI: group B, n=57) were enrolled finally. The embolic agent CalliSpheres (100-300, 300-500, or 500-700 µm) loaded with gemcitabine (800 mg) was administered during the DEB-BACE procedure. The adverse events (AEs) and outcomes were compared. Of these, the median progression-free survival (PFS) and overall survival (OS) were compared via Kaplan-Meier (KM) methods. Univariate and multivariate Cox regression analyses were used to investigate the predictors of PFS and OS. Results: KM methods showed that group A had longer median PFS (12.0 vs. 3.0 months, P<0.001) and OS (27.0 vs. 8.0 months, P<0.001) than group B. The predictors of PFS for DEB-BACE/BAI included tumor diameter (P=0.013), immunotherapy (P<0.001), and DEB-BACE/BAI cycles (P=0.012), whereas the predictors of OS included tumor diameter (P=0.021), extrapulmonary metastases (P=0.041), immunotherapy (P<0.001), and DEB-BACE/BAI cycles (P=0.020). The incidence rates of overall AEs in groups A and B were 40.7% (11/27) and 36.8% (21/57), respectively, and no significant difference was found (P=0.731). Group A had an incidence rate of 11.1% for grade 3 immunotherapy-related AEs (irAEs). There were no incidences of ectopic embolization or spinal artery injury. Conclusions: Compared with DEB-BACE/BAI, PD-1 blockade plus DEB-BACE/BAI could improve the prognosis for advanced NSCLC despite the associated risk of grade 3 irAEs. The combination regimens are promising and safe approaches for advanced NSCLC.

Microwave Ablation for Inoperable Stage I Non-Small Cell Lung Cancer in Patients Aged ≥70 Years: A Prospective, Single-Center Study.

PURPOSE: To evaluate the safety and survival outcomes of computed tomography-guided microwave ablation (MWA) for medically inoperable Stage I non-small cell lung cancer (NSCLC) in patients aged ≥70 years. MATERIALS AND METHODS: This study was a prospective, single-arm, single-center clinical trial. The MWA clinical trial enrolled patients aged ≥70 years with medically inoperable Stage I NSCLC from January 2021 to October 2021. All patients received biopsy and MWA synchronously with the coaxial technique. The primary endpoints were 1-year overall survival (OS) and progression-free survival (PFS). The secondary endpoint was adverse events. RESULTS: A total of 103 patients were enrolled. Ninety-seven patients were eligible and analyzed. The median age was 75 years (range, 70-91 years). The median diameter of tumors was 16 mm (range, 6-33 mm). Adenocarcinoma (87.6%) was the most common histologic finding. With a median follow-up of 16.0 months, the 1-year OS and PFS rates were 99.0% and 93.7%, respectively. There were no procedure-related deaths in any patient within 30 days after MWA. Most of the adverse events were minor. CONCLUSION: MWA is an effective and safe treatment for patients aged ≥70 years with medically inoperable Stage I NSCLC.

Diagnostic performance and safety of percutaneous fine-needle aspiration immediately before microwave ablation for pulmonary ground-glass nodules.

Background: This study sought to evaluate the safety and diagnostic performance of computed tomography (CT)-guided fine-needle aspiration (FNA) immediately before microwave ablation (MWA) for pulmonary ground-glass nodules (GGNs). Methods: This retrospective study analyzed the synchronous CT-guided biopsy and MWA data of 92 GGNs (male to female ratio 37:55; age 60.4±12.5 years; size 1.4±0.6 cm). FNA was performed in all patients, and sequential core-needle biopsy (CNB) was performed in 62 patients. The positive diagnosis rate was determined. The diagnostic yield was compared on the basis of the biopsy methods (FNA, CNB, or both), the nodule diameter (<1.5 and ≥1.5 cm), and the lesion component (pure GGN or part-solid GGN). The procedure-related complications were recorded. Results: The technical success rate was 100%. The positive rates of FNA and CNB were 70.7% and 72.6% respectively, but did not differ significantly (P=0.8). Sequential FNA and CNB showed better diagnostic performance (88.7%) than did either alone (P=0.008 and P=0.023, respectively). The diagnostic yield of CNB for pure GGNs was significantly lower than that for part-solid GGNs (P=0.016). The diagnostic yield was lower for smaller nodules (78.3% vs. 87.5%; P=0.28), but the differences were not significant. Grade 1 pulmonary hemorrhages were observed in 10 (10.9%) sessions after FNA, including 8 cases of hemorrhage along the needle track and 2 cases of perilesional hemorrhage, but these hemorrhages did not hamper the accuracy of the antenna placement. Conclusions: FNA immediately before MWA is a reliable technique for the diagnosis of GGNs that does not alter the accuracy of the antenna placement. Sequential FNA and CNB improves the diagnostic ability of GGNs compared to either method used alone.

Standard treatment-refractory/ineligible small cell lung cancer treated with drug-eluting beads bronchial arterial chemoembolization: a retrospective cohort study.

Background: Patients with small cell lung cancer (SCLC) are prone to developing refractoriness to standard treatment, and some patients are ineligible for systemic therapy owing to comorbidities or poor pulmonary function. The prognosis of patient with standard treatment-refractory/ineligible (STRI)-SCLC remains poor. This retrospective cohort study aimed to investigate the efficacy and safety of drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) for the treatment of SRTI-SCLC and to identify the predictors of overall survival (OS). Methods: A total of 18 patients with STRI-SCLC who received DEB-BACE were included. Treatment response, adverse events, progression-free survival (PFS), and OS were evaluated. Further molecular targeted therapy or immunotherapy was administered as a second-line treatment or beyond for those patients who had not received these regimens previously. Univariate and multivariate Cox analyses were used to explore the predictors of OS for STRI-SCLC treated with DEB-BACE. Results: The overall disease control rate at 3 months after DEB-BACE was 77.8% (14/18); of these patients who experienced disease control, partial response and stable disease were achieved in 2 patients (11.1%) and 12 patients (66.7%), respectively. There were 7 patients (38.9%) who received anlotinib after DEB-BACE. No severe DEB-BACE-related or anlotinib-related adverse events were observed. The median PFS was 5.0 months; the 6- and 12-month PFS rates were 55.6% (10/18) and 11.1% (2/18), respectively. The median OS was 9.0 months; the 6- and 12-month OS rates were 77.8% (14/18) and 33.3% (6/18), respectively. Postoperative anlotinib [hazard ratio: 0.302; 95% confidence interval (CI): 0.098-0.930; P=0.037] was identified as the predictor of OS in patients with STRI-SCLC treated with DEB-BACE. Conclusions: DEB-BACE is an effective and well-tolerated approach for patients with STRI-SCLC. Postoperative anlotinib is the predictor of OS and may indicate a better prognosis for patients with STRI-SCLC.

Comparison of analgesic effect in celiac plexus neurolysis: Ethanol injection with or without iodine-125 radioactive seeds implantation.

Context: Currently, short-term recurrence of pain is the biggest clinical challenge of celiac plexus neurolysis for patients with refractory abdominal cancer pain. Aim: To evaluate the analgesic effect and safety of celiac plexus neurolysis using ethanol injection combined with iodine-125 (125I) radioactive seed implantation for refractory abdominal cancer pain. Settings and Design: The study was a randomized controlled trial. Methods and Materials: About 10 patients with severe refractory abdominal cancer pain were enrolled in this study. The patients were randomly divided into group A (ethanol injection combined with 125I radioactive seed implantation, n = 5) and group B (ethanol injection alone, n = 5). The primary end point was pain relief measured by means of numerical rating scale (NRS). And the secondary end point was mean administration of analgesic drugs and the safety of the procedure. Statistical Analysis Used: Repeated measures of analysis of variance were used for statistical analysis. Results: The NRS scores were significantly reduced by 24 h postprocedure in both groups (group A: P = 0.001 and group B: P = 0.001). Group A did not show significant recurrence based on NRS scores during the follow-up period. In contrast, the NRS scores recurred significantly in group B by 1 month postprocedure (P = 0.026). The intake of analgesic drugs was significantly reduced in both the groups postprocedure (group A: P = 0.013 and group B: P = 0.013). Overall, it was significantly lower in group A than in group B (P = 0.041). No treatment-related deaths or major complications were observed. Conclusions: Celiac plexus neurolysis using ethanol injection in combination with 125I radioactive seed implantation has a longer analgesic duration than using ethanol injection alone. It could be a safe and long-lasting analgesic approach for managing refractory abdominal cancer pain.

Computed tomography-guided microwave ablation for non-small cell lung cancer patients on antithrombotic therapy: a retrospective cohort study.

Background: For non-small cell lung cancer (NSCLC) patients on antithrombotic therapy who are treated with microwave ablation (MWA), the transient interruption of antithrombotic agents may increase the risk of thromboembolism, and continuation of antithrombotic agents may increase the risk of intraprocedural hemorrhage. This retrospective cohort study aimed to explore the safety of MWA in patients with NSCLC on antithrombotic therapy. Methods: A total of 572 patients with NSCLC (antithrombotic therapy group: n=84, Group A; control group: n=488, Group B) who received MWA were included. Antithrombotic agent use was suspended before MWA and resumed as soon as possible after MWA. Hemorrhagic (hemothorax and hemoptysis) and thromboembolic complications (pulmonary embolism, cerebral infarction, and angina) were compared. Logistic regression analyses were used to investigate the predictors of hemorrhagic complications after MWA. Results: Hemorrhagic complications occurred in 8 participants (9.5%) from Group A and 33 participants (6.8%) from Group B, and no statistically significant difference was found (P=0.365). There were 3 participants (0.5%) who developed thromboembolic complications, including 1 case (1.2%, 1/84) of pulmonary embolism in Group A, and 2 cases (0.4%, 2/488) of cerebral infarction or angina in Group B; no significant difference was found (P=0.923). In the subgroup analyses of Group A, no statistically significant difference of hemorrhagic (P>0.999) or thromboembolic complications (P>0.999) was found between patients who received and did not receive bridging anticoagulation with heparin. Logistic regression analyses revealed that direct contact of a tumor with vessels ≥2 mm was a predictor of hemorrhagic complications [hazard ratio (HR) =2.318; 95% confidence interval (CI): 1.215-4.420; P=0.011], while antithrombotic therapy was irrelevant. Conclusions: With the appropriate cessation and resumption of antithrombotic agents, patients with NSCLC on antithrombotic therapy have comparable incidence rates of hemorrhagic and thromboembolic complications after MWA to those of patients who are not on antithrombotic therapy. Therefore, with appropriate cessation, MWA appears to generally be safe for NSCLC patients on antithrombotic therapy.

Nerve Injury and Regeneration after Neurolysis: Ethanol Alone versus Ethanol with Brachytherapy in Rabbits.

PURPOSE: This study aimed to prove the hypothesis that neurolysis based on ethanol injection in combination with iodine-125 (125I) radioactive seed implantation could prolong the nerve regeneration time compared with that based on ethanol injection alone. The grade of nerve injury was assessed for both methods. MATERIALS AND METHODS: Twenty female rabbits (mean weight, 2.8 kg ± 0.2) were randomly assigned to group A (neurolysis of the left brachial plexus nerve based on ethanol injection in combination with 125I radioactive seed implantation, n = 10) and group B (neurolysis using ethanol injection alone, n = 10). The right brachial plexus nerve was used as a control. Injury and regeneration of the brachial plexus nerve were analyzed using electromyography. Statistical tests were performed using the Mann-Whitney U test and repeated-measures analysis of variance. The results were verified with histopathological examinations. RESULTS: The overall postprocedural amplitude was significantly lower in group A than in group B (P = .01), particularly in the second month after the procedure (P = .036). However, no statistical difference in latency was observed between the 2 groups (P = .103). Histopathological examination of both groups revealed Sunderland third-degree peripheral nerve injury (PNI), which was mainly characterized by axonal disintegration. The degree of nerve regeneration was significantly lower in group A than in group B. CONCLUSIONS: Neurolysis based on ethanol injection in combination with 125I radioactive seed implantation can prolong the nerve regeneration time compared with that based on ethanol injection alone, although both methods resulted in Sunderland third-degree PNI.

Effect of hepatic artery resection and reconstruction on the prognosis of patients with advanced hilar cholangiocarcinoma.

BACKGROUND: Hilar cholangiocarcinoma (HC) is a good adaptation certificate of hepatic arterectomy, and hepatic arterectomy is conductive to the radical resection of cholangiocarcinoma, which simplifies the operation and helps with a combined resection of the peripheral portal tissue. With continuous development of surgical techniques, especially microsurgical technique, vascular invasion is no longer a contraindication to surgery in the past 10 years. However, hepatic artery reconstruction after hepatic arterectomy has been performed to treat liver tumor in many centers with better results, but it is rarely applied in advanced HC. AIM: To determine the prognosis of patients with advanced HC after hepatic artery resection and reconstruction. METHODS: A total of 98 patients with HC who underwent radical operation in our hospital were selected for this retrospective analysis. According to whether the patients underwent hepatic artery resection and reconstruction or not, they were divided into reconstruction (n = 40) and control (n = 58) groups. The traumatic indices, surgical resection margin, liver function tests before and after the operation, and surgical complications were compared between the two groups. RESULTS: Operation time, blood loss, hospital stay, and gastrointestinal function recovery time were higher in the reconstruction group than in the control group (P < 0.05); The R0 resection rates were 90.00% and 72.41% in the reconstruction and control groups, respectively (P < 0.05). Serum alanine aminotransferase was lower in the reconstruction group on day one and three postoperatively, whereas serum aspartate aminotransferase was lower on the third day (P < 0.05). Preoperatively, the Karnofsky performance status scores were similar between the groups (P > 0.05), but was higher in the reconstruction group (P < 0.05) two weeks postoperatively. There was no difference in the complication rate between the two groups (27.50% vs 32.67%, P > 0.05). Two-year survival rate (42.50% vs 39.66%) and two-year survival time (22.0 mo vs 23.0 mo) were similar between the groups (P > 0.05). CONCLUSION: Radical surgery combined with reconstruction after hepatic artery resection improves R0 resection rate and reduces postoperative liver injury in advanced HC. However, the operation is difficult and the effect on survival time is not clear.

Drug-Eluting Bead Bronchial Arterial Chemoembolization With and Without Microwave Ablation for the Treatment of Advanced and Standard Treatment-Refractory/Ineligible Non-Small Cell Lung Cancer: A Comparative Study.

Purpose: To compare the outcomes of drug-eluting bead bronchial arterial chemoembolization (DEB-BACE) with and without microwave ablation (MWA) for the treatment of advanced and standard treatment-refractory/ineligible non-small cell lung cancer (ASTRI-NSCLC). Materials and Methods: A total of 77 ASTRI-NSCLC patients who received DEB-BACE combined with MWA (group A; n = 28) or DEB-BACE alone (group B; n = 49) were included. Clinical outcomes were compared between groups A and B. Kaplan-Meier methods were used to compare the median progression-free survival (PFS) or overall survival (OS) between the two groups. Univariate and multivariate Cox proportional hazards analyses were used to investigate the predictors of OS for ASTRI-NSCLC treated with DEB-BACE. Results: No severe adverse event was found in both groups. Pneumothorax was the predominant MWA-related complication in group A, with an incidence rate of 32.1% (9/28). Meanwhile, no significant difference was found in DEB-BACE-related complications between groups A and B. The overall disease control rate (DCR) was 61.0% (47/77), with a significantly higher DCR in group A (85.7% vs. 46.9%, P = 0.002). The median PFS in groups A and B was 7.0 and 4.0 months, respectively, with a significant difference (P = 0.037). The median OS in groups A and B was both 8.0 months, with no significant difference (P = 0.318). The 6-month PFS and OS rates in groups A and B were 75.0% and 78.6%, 22.4% and 59.2%, respectively, while the 12-month PFS and OS rates in groups A and B were 17.9% and 28.6%, 14.3% and 22.4%, respectively. Of these, a significantly higher 6-month PFS rate was found in group A (75.0% vs. 22.4%; P < 0.001). The cycles of DEB-BACE/bronchial artery infusion chemotherapy [hazard ratio (HR): 0.363; 95% confidence interval (CI): 0.202-0.655; P = 0.001] and postoperative immunotherapy (HR: 0.219; 95% CI: 0.085-0.561; P = 0.002) were identified as the predictors of OS in ASTRI-NSCLC treated with DEB-BACE. Conclusion: MWA sequentially combined with DEB-BACE was superior to DEB-BACE alone in the local control of ASTRI-NSCLC. Although the combination therapy reveals a trend of prolonging the OS, long-term prognosis warrants an investigation with a longer follow-up.

Correlations of RENAL, PADUA and NePhRO Scores With Complications and Outcomes in Patients After CT-Guided Microwave Ablation of Renal Tumors.

OBJECTIVE: This retrospective study aimed to access the correlations of RENAL, PADUA and NePhRO scores with operative complications, chronic kidney disease (CKD) upstaging, and oncologic outcomes after CT-guided percutaneous Microwave Ablation (MWA) of renal tumors in order to determine their status as independent predictors of outcomes after MWA. This study also aimed to generally evaluate the efficacy of MWA in treating renal tumors. METHODS: From January 2017 to December 2019, 18 patients with 27 renal tumors who had undergone simultaneous biopsy and MWA were recruited in this single-center retrospective study. Data collection included tumor characteristics, procedural protocols, complications, CKD upstaging data, local tumor control data and overall survival. All lesions were evaluated using RENAL, PADUA and NePhRO scores, and further analysis was performed to determine whether the scores were correlated with operative complications, CKD upstaging, local tumor control and overall survival. RESULTS: The minor and major complication rates were 16.7% and 0%, respectively. Two patients with solitary kidney experienced CKD upstaging. Local tumor recurrence was identified in one type of tumor (3.7%) in the first year of follow-up. L. parameter (P = .031), longitudinal (polar) location score (P = .011), Ne. parameter (P = .036), number of kidneys (P = .005), and number of lesions (P = .008), were predictive factors significantly associated with the occurrence of complications. Besides, CKD upstaging was associated with A. parameter (P = .032) and urinary collecting system score (P = .028). RENAL, PADUA, and NePhRO scores were significantly correlated with complications, overall survival, and CKD upstaging, respectively (P < .05). CONCLUSION: CT-guided percutaneous MWA was found to be a valuable alternative in the treatment of renal tumors for selected patients. Furthermore, RENAL, PADUA and NePhRO scores were not independent predictors of outcomes of MWA.

Sintilimab plus Bronchial Arterial Infusion Chemotherapy/Drug-Eluting Embolic Chemoembolization for Advanced Non-Small Cell Lung Cancer: A Preliminary Study of 10 Patients.

PURPOSE: To evaluate the short-term efficacy and safety of immunotherapy with sintilimab combined with bronchial arterial infusion (BAI) chemotherapy/drug-eluting embolic (DEE) bronchial arterial chemoembolization (BACE) for advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Ten patients with advanced NSCLC were treated with sintilimab plus BAI/DEE-BACE between December 2019 and November 2020 and retrospectively evaluated. The Response Evaluation Criteria in Solid Tumors version 1.1 was applied to evaluate the treatment response. The local tumor control duration, progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier analysis. RESULTS: At 30 days after the last multimodal treatment, complete response, partial response, and stable disease were recorded in 1 (10%), 7 (70%), and 2 (20%) patients, respectively, for an objective response rate of 80% and a disease control rate of 100%. No patient experienced progressive disease. The median duration of local tumor control was 8.0 months (95% CI, 6.2-9.7 months). The median PFS and OS were 11.0 months (95% CI, 6.9-15.1 months) and 8.0 months (95% CI, 5.5-10.5 months), respectively. Two cases of Grade III adverse events related to medications were reported. CONCLUSIONS: Sintilimab combined with BAI/DEE-BACE for patients with advanced NSCLC appears to be safe and feasible. Compared with previous studies on BAI/DEE-BACE, the addition of immunotherapy may improve survival.

Local progression after computed tomography-guided microwave ablation in non-small cell lung cancer patients: prediction using a nomogram model.

OBJECTIVES: To develop an effective nomogram model for predicting the local progression after computed tomography-guided microwave ablation (MWA) in non-small cell lung cancer (NSCLC) patients. METHODS: NSCLC patients treated with MWA were randomly allocated to either the training cohort or the validation cohort (4:1). The predictors of local progression identified by univariable and multivariable analyses in the training cohort were used to develop a nomogram model. The C-statistic was used to evaluate the predictive accuracy in both the training and validation cohorts. RESULTS: A total of 304 patients (training cohort: n = 250; validation cohort: n = 54) were included in this study. The predictors selected into the nomogram for local progression included the tumor subtypes (odds ratio [OR], 2.494; 95% confidence interval [CI], 1.415-4.396, p = 0.002), vessels ≥3 mm in direct contact with tumor (OR, 2.750; 95% CI, 1.263-5.988; p = 0.011), tumor diameter (OR, 2.252; 95% CI, 1.034-4.903; p = 0.041) and location (OR, 2.442; 95% CI, 1.201-4.965; p = 0.014). The C-statistic showed good predictive performance in both cohorts, with a C-statistic of 0.777 (95% CI, 0.707-0.848) internally and 0.712 (95% CI, 0.570-0.855) externally (training cohort and validation cohort, respectively). The optimal cutoff value for the risk of local progression was 0.39. CONCLUSIONS: Tumor subtypes, vessels ≥3 mm in direct contact with the tumor, tumor diameter and location were predictors of local progression after MWA in NSCLC patients. The nomogram model could effectively predict the risk of local progression after MWA. Patients showing a high risk (>0.39) on the nomogram should be monitored for local progression.

Computed tomography-guided microwave ablation for the treatment of non-small cell lung cancer patients with and without adjacent lobe invasion: A comparative study.

BACKGROUND: The aim of the study was to explore the outcomes of computed tomography-guided microwave ablation (MWA) in non-small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI), and to compare the outcomes of ALI-NSCLC and non-ALI NSCLC patients after MWA. METHODS: A total of 319 NSCLC patients and 366 tumors treated with MWA were included in the study, comprising 34 ALI-NSCLC patients and 285 non-ALI NSCLC patients. Complications, local recurrence rates, progression-free survival (PFS), and overall survival (OS) were compared. Logistic regression analyses were used to investigate the correlation between ALI and the occurrence of pneumothorax after MWA. RESULTS: The mean tumor diameter of ablated tumors was 3.6 ± 2.2 cm. There were 95 (29.8%) NSCLC patients in which pneumothorax occurred after MWA, and all patients recovered. Of these, the ALI group had a significantly higher incidence rate of pneumothorax than the non-ALI group (52.9% vs. 27.0%, p = 0.002). The median PFS and OS for the ALI group were 12.0 ± 10.2 and 15.5 ± 9.5 months, respectively, and that of the non-ALI group were 13.0 ± 10.6 and 17.0 ± 11.1 months, respectively, and no significant difference was found in PFS (p = 0.329) nor OS (p = 0.394) between the two groups. Local recurrence rates for ALI and non-ALI groups were 29.4% and 20.7%, respectively, and no significant difference was found (p = 0.244). Logistic regression analyses revealed that ALI can increase the risk of pneumothorax (hazard ratio [HR], 2.867; p = 0.012). CONCLUSIONS: MWA is an effective and safe approach for ALI-NSCLC treatment. Although ALI can increase the risk of pneumothorax, ALI-NSCLC patients reveal a comparable outcome to non-ALI NSCLC patients after MWA.

A Comparative Study of Cavitary and Noncavitary Non-small Cell Lung Cancer Patients Treated with CT-Guided Microwave Ablation.

PURPOSE: To explore the outcomes of computed tomography‒guided microwave (MW) ablation in patients with cavitary non-small cell lung cancer (NSCLC) and to compare the outcomes of cavitary and noncavitary NSCLC treated with MW ablation. MATERIALS AND METHODS: A total of 317 patients with NSCLC (194 men and 123 women) treated with MW ablation were include: 19 patients with cavitary NSCLC and 298 patients with noncavitary NSCLC. Complications, progression-free survival (PFS), and overall survival (OS) were evaluated and compared between the 2 groups. The Kaplan-Meier method was used to investigate the correlation of cavity and OS in patients with NSCLC. RESULTS: A total of 364 MW ablation procedures were performed. Adenocarcinoma was the predominant histopathological subtype in patients with cavitary NSCLC (73.7%). Cavitary NSCLC had an incidence rate of 57.9% in overall complications, which was significantly higher than that of 34.6% for noncavitary NSCLC (P = .040). In a mean follow-up of 27.2 months ± 11.9, the median PFS and OS for cavitary NSCLC were 9.0 months ± 8.5 and 14.0 months ± 10.8, respectively, and those for noncavitary NSCLC were 13.0 months ± 10.7 and 17.0 months ± 10.9, respectively. There was no significant difference in PFS (P = .180) or OS (P = .133) between cavitary and noncavitary NSCLC. In addition, the local recurrence rates for cavitary and noncavitary NSCLC were 15.8% and 21.5%, respectively, and no significant difference was found (P = .765). The Kaplan-Meier method revealed no association between the cavity and OS in patients with NSCLC treated with MW ablation. CONCLUSIONS: MW ablation was an effective and safe approach for cavitary NSCLC treatment. Compared with noncavitary NSCLC, cavitary NSCLC manifested with more complications but a comparable outcome after MW ablation.

Risk prediction of pneumothorax in lung malignancy patients treated with percutaneous microwave ablation: development of nomogram model.

OBJECTIVES: To develop effective nomograms for predicting pneumothorax and delayed pneumothorax after microwave ablation (MWA) in lung malignancy (LM) patients. METHODS: LM patients treated with MWA were randomly allocated to a training or validation cohort at a ratio of 7:3. The predictors of pneumothorax identified by univariate and multivariate analyses in the training cohort were used to develop a predictive nomogram. The C-statistic was used to evaluate predictive accuracy in both cohorts. A second nomogram for predicting delayed pneumothorax was developed and validated using identical methods. RESULTS: A total of 552 patients (training cohort: n = 402; validation cohort: n = 150) were included; of these patients, 27.9% (154/552) developed pneumothorax, with immediate and delayed pneumothorax occurring in 18.8% (104/552) and 9.1% (50/552), respectively. The predictors selected for the nomogram of pneumothorax were emphysema (hazard ratio [HR], 6.543; p < .001), history of lung ablation (HR, 7.841; p= .025), number of pleural punctures (HR, 1.416; p < .050), ablation zone encompassing pleura (HR, 10.225; p < .001) and pulmonary fissure traversed by needle (HR, 10.776; p < .001). The C-statistics showed good predictive performance in the training and validation cohorts (0.792 and 0.832, respectively). Another nomogram for delayed pneumothorax was developed based on emphysema (HR, 2.952; p= .005), ablation zone encompassing pleura (HR, 4.915; p < .001) and pulmonary fissure traversed by needle (HR, 4.348; p = .015). The C-statistics showed good predictive performance in the training cohort, and it had efficacy for prediction in the validation cohort (0.719 and 0.689, respectively). CONCLUSIONS: The nomograms could effectively predict the risk of pneumothorax and delayed pneumothorax after MWA.