Survival outcomes of radiofrequency ablation compared with surgery in patients with early-stage primary non-small-cell lung cancer: A meta-analysis

Efficacy and Safety of thermal ablation for Patients With stage I non-small cell lung cancer

RATIONALE AND OBJECTIVES

The objective of this study was to measure the safety and efficacy of thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), for patients with stage I non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

The databases PubMed was searched from inception to November 2023 to identify relevant studies. Statistical analyses were performed with R version 3. 6. 3.

RESULTS

Thirty-three studies involving 1400 patients were finally included. According to our study, the incidence of patients with stage I NSCLC who were older than 60 years old was 98 % (95 % CI [94-100 %]); the lesions were mostly located in RUL (Right Upper Lobe) and LUL (Left Upper Lobe), and the incidence of the two sites was 29 % (95 % CI [23-35 %]) and 27 % (95 % CI [21-33 %]), respectively; the types of lung cancers mainly included adenocarcinoma, squamous carcinoma, and large-cell lung cancer, of which adenocarcinoma accounted for the largest proportion of 63 % (95 % CI [56-70 %]); the causes of death were mainly categorized into cancer-related (57 %, 95 %CI[40-74 %]) and noncancer-related (40 %, 95 %CI [23-58 %]); the common complications in the postoperative period were pneumothorax and pain, with the incidence of 33 % (95 %CI[24-44 %]) and 33 % (95 %CI[19-50 %]), and the rate of the postoperative complications in MWA was slightly higher than those in RFA; the local recurrence rate was 23 % (95 %CI[17-29 %]) and the distant recurrence rate was 18 % (95 %CI[7-32 %]); the pooling result showed the rate of 1-, 2-, 3-, and 5-year survival rate were 96 %, 81 %, 68 %, and 42 %, the Cancer-specific survival (CSS) rates at 1, 2, 3, and 5 years were 98 %, 88 %, 75 %, and 58 %, Disease-free survival (DFS) rates at 1, 2, 3, and 5 years were 87 %, 63 %, 57 %, and 42 %, there were no significant differences existed between the RFA group and MWA group in survival rate, CSS and DFS.

CONCLUSION

Ablation therapy is safe and effective for stage I NSCLC patient. MWA and RFA have comparable efficacy, safety, and prognosis, which could be recommended for patients with stageⅠNSCLC, especially for patients who cannot tolerate open surgery.

Interventional bronchoscopy in lung cancer treatment

Interventional bronchoscopy has seen significant advancements in recent decades, particularly in the context of lung cancer. This method has expanded not only diagnostic capabilities but also therapeutic options. In this article, we will outline various therapeutic approaches employed through either a rigid or flexible bronchoscope in multimodal lung cancer treatment. A pivotal focus lies in addressing central airway obstruction resulting from cancer. We will delve into the treatment of initial malignant changes in central airways and explore the rapidly evolving domain of early peripheral malignant lesions, increasingly discovered incidentally or through lung cancer screening programmes. A successful interventional bronchoscopic procedure not only alleviates severe symptoms but also enhances the patient's functional status, paving the way for subsequent multimodal treatments and thereby extending the possibilities for survival. Interventional bronchoscopy proves effective in treating initial cancerous changes in patients unsuitable for surgical or other aggressive treatments due to accompanying diseases. The key advantage of interventional bronchoscopy lies in its minimal invasiveness, effectiveness and favourable safety profile.

Efficacy and safety of local ablative therapy for patients with NSCLC and coexisting interstitial lung disease

BACKGROUND

The effective therapeutic approach is still an unmet need for patients diagnosed with both lung cancer and interstitial lung disease (ILD). This is primarily due to the possible risk of ILD exacerbation caused by surgery or radiotherapy. The current study aimed to investigate the efficacy and safety of local ablative therapy (LAT) for this specific population.

METHODS

Consecutive patients with non-small cell lung cancer (NSCLC) and ILD who received LAT between January 2018 and August 2022 were enrolled, and propensity score matching (PSM) was utilized to match the non-ILD group. The primary endpoint was recurrence-free survival (RFS), and secondary endpoints included overall survival (OS), adverse events (AEs) and hospital length of stay (HLOS).

RESULTS

The PSM algorithm yielded matched pairs in the ILD group (n = 25) and non-ILD group (n = 72) at a ratio of 1:3. There were no statistically significant differences in RFS (median 16.4 vs. 18 months; HR = 1.452, p = 0.259) and OS (median: not reached vs. 47.9 months; HR = 1.096, p = 0.884) between the two groups. Meanwhile, no acute exacerbation of ILD was observed in the ILD group. However, the incidence of pneumothorax, especially pneumothorax requiring chest tube drainage, was significantly higher (36.0% vs. 11.2%, p = 0.005) among patients with NSCLC and co-existing ILD, which resulted in longer HLOS (p = 0.045).

CONCLUSION

Although ILD was associated with a higher incidence of pneumothorax, the efficacy of LAT for NSCLC patients with ILD was comparable to those without ILD, suggesting that LAT might be a reliable and effective treatment option for this population, particularly in the early stage.

Two-scale assessment of anxiety and depression in postoperative non-small cell lung cancer patients: their prevalence, risk factors, and prognostic potency

OBJECTIVE

Anxiety and depression commonly occur and correlate with poor prognosis in patients with cancer. The study aimed to assess the anxiety and depression in patients with postsurgical non-small cell lung cancer (NSCLC) using both Hospital Anxiety and Depression Scale (HADS) and Self-Rating Anxiety/Depression Scale (SAS/SDS) and to investigate their risk factors and linkage with prognosis.

METHODS

HADS and SAS/SDS were assessed in 350 patients with NSCLC at 3 months after surgical resection and 100 healthy controls (HCs). Patients with NSCLC were followed up for a median period of 27.0 (range: 6.0-52.0) months for prognostic evaluation.

RESULTS

HADS-identified anxiety rate (39.7% vs. 10.0%, P < 0.001), SAS-identified anxiety rate (34.9% vs. 9.0%, P < 0.001), HADS-identified depression rate (29.7% vs. 5.0%, P < 0.001), and SDS-identified depression rate (27.1% vs. 6.0%, P < 0.001) were all elevated in patients with NSCLC vs. HCs. Multivariate logistic regression analysis uncovered that diabetes, adjuvant therapy, postoperative complications, and poor differentiation were independently linked with increased HADS- or SAS-identified anxiety risk (all P < 0.05); meanwhile, female gender, hypertension, diabetes, poor differentiation, adjuvant therapy, postoperative complications, and TNM stage were independently linked with increased HADS- or SDS-identified depression risk (all P < 0.05). Furthermore, HADS-identified anxiety, SAS-identified anxiety, HADS-identified depression, and SDS-identified depression independently predicted shorter disease-free survival and overall survival (all P < 0.05).

CONCLUSION

Anxiety and depression are prevalent and linked with poor survival in patients with postsurgical NSCLC. Meanwhile, gender, comorbidities, advanced tumor features, adjuvant therapy, and postoperative complications relate to the prevalence of anxiety and depression.