Abstract

Objectives

To explore the outcomes of CT-guided percutaneous microwave ablation (MWA) in non-small cell lung cancer (NSCLC) patients, and then develop an effective nomogram to predict the survival.

Methods

NSCLC patients treated with MWA were randomly allocated to either the training cohort or the validation cohort (3:1). The primary outcome measurement was overall survival (OS), whose predictors were identified by univariate and multivariate analyses in the training cohort. Then, a predictive nomogram was developed to predict the OS, with the predictive accuracy evaluated by C-statistic and receiver operating characteristic in both the training and validation cohorts.

Results

A total of 234 patients (training cohort: n = 176; validation cohort: n = 58) and 271 tumors with a median OS of 17.0 ± 12.2 months were included. The predictors selected into the nomogram included tumor diameter (hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.37-3.30; p < 0.001), extrapulmonary metastases (HR, 1.77; 95% CI, 1.06–2.95; p = 0.030), tumor stage (HR, 1.38; 95% CI, 1.07–1.79; p = 0.013), tumor type (HR, 2.00; 95% CI, 1.48–2.72; p < 0.001) and post-MWA TKIs (HR, 0.55; 95% CI, 0.34–0.89; p < 0.001), based on the results of univariate and multivariate analyses. The C-statistic showed good predictive performance, with a C-statistic of 0.838 (95% CI, 0.779–0.897) internally and 0.808 (95% CI, 0.695–0.920) externally (training cohort and validation cohort, respectively).

Conclusions

The nomogram was effective in predicting the OS in NSCLC patients treated with MWA, and could be applied to identify patients who may benefit most from MWA and be helpful for clinical decision making.

中文翻译：

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CT引导微波消融治疗非小细胞肺癌患者的生存预测：预后列线图的开发

摘要

目标

为了探讨非小细胞肺癌（NSCLC）患者CT引导下经皮微波消融（MWA）的结果，然后开发有效的诺模图来预测存活率。

方法

用MWA治疗的NSCLC患者被随机分配到训练队列或验证队列（3：1）。主要结局指标是总体生存期（OS），其预测因素是通过训练队列中的单变量和多变量分析确定的。然后，开发了预测列线图来预测OS，并通过训练和验证队列中的C统计量和接收器操作特性来评估预测精度。

结果

总共有234名患者（训练组：Ñ  = 176;验证群组：Ñ  = 58）和271肿瘤17.0±12.2个月一个位OS都包括在内。诺模图中选择的预测因子包括肿瘤直径（危险比[HR]，2.12； 95％置信区间[CI]，1.37-3.30；p  <0.001），肺外转移（HR，1.77； 95％CI，1.06-2.95；和p  = 0.030），肿瘤分期（HR，1.38; 95％CI，1.07–1.79; p  = 0.013），肿瘤类型（HR，2.00; 95％CI，1.48–2.72; p  <0.001）和MWA后TKI（ HR，0.55； 95％CI，0.34-0.89；p  <0.001），基于单变量和多变量分析的结果。该ç-统计量显示出良好的预测性能，内部-C统计量为0.838（95％CI，0.779–0.897），外部为0.808（95％CI，0.695–0.920）（分别为训练队列和验证队列）。

结论

诺模图可有效预测接受MWA治疗的NSCLC患者的OS，并可用于识别可能从MWA获益最大并有助于临床决策的患者。