Abstract

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.

中文翻译：

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经皮微波消融治疗肺恶性肿瘤患者气胸的风险预测：诺模图模型的建立

摘要

目标

要开发有效的诺模图，以预测肺恶性肿瘤（LM）患者在微波消融（MWA）后发生气胸和迟发性气胸。

方法

用MWA治疗的LM患者以7：3的比例随机分配到训练或验证队列中。在训练队列中通过单因素和多因素分析确定的气胸预测因子用于建立预测列线图。该Ç t-统计被用来评估在两个同伙预测准确性。使用相同的方法开发并验证了用于预测延迟性气胸的第二列线图。

结果

总共 纳入552例患者（培训队列：n  = 402；验证队列：n = 150）；在这些患者中，有27.9％（154/552）患气胸，立即和延迟性气胸的发生率分别为18.8％（104/552）和9.1％（50/552）。气胸诺模图选择的预测因子为肺气肿（危险比[HR]，6.543；p  <.001），肺消融史（HR，7.841；p = .025），胸膜穿刺次数（HR，1.416；p）  <.050），消融区域包括胸膜（HR，10.225; p  <.001）和针头横穿的肺裂（HR，10.776; p  <.001）。该ç-统计量在训练和验证队列中显示出良好的预测性能（分别为0.792和0.832）。根据肺气肿（HR，2.952；p = .005），消融区域（包括胸膜）（HR，4.915；p  <.001）和经针穿刺的肺裂（HR，4.348；p = .015 ），开发了另一项延迟气胸的诺模图。）。该Ç -statistics显示，在训练队列良好的预测性能，并且它有在验证队列（0.719和0.689，分别）预测功效。

结论

诺模图可以有效预测MWA后发生气胸和迟发性气胸的风险。