| OBJECTIVE To investigate the safety,efficacy,quality of life and prognosis of spinal cord compression in patients with non-small cell lung cancer with spinal ablation by in vitro experiments and clinical results.METHODS In vitro high-grade sarcoma was used to simulate solid tumors in vivo.Microwave ablation equipment(frequency 2450MHz)was used to set the power to 40,60,80,100 W,respectively.Each power was ablated 5 solid tumor specimens for 10 min,and the tumor tissue ablation zone was coagulated.The morphology of the necrosis,the size of the lesion and the distribution of the thermal field of the temperature,and the histopathological changes of the tissue after ablation were evaluated by histopathology.Through this in vitro experiment,the microwave ablation power and time of action for spinal ablation in the microwave ablation were obtained,and the value was applied to the clinical application of microwave ablation of spinal metastases.Retrospective analysis of non-small cell lung cancer spinal metastases spinal cord compression by microwave ablation combined with spinal decompression and internal fixation and clinical data of patients with spinal decompression and internal fixation,analysis of microwave ablation for non-small cell lung cancer spinal metastases spinal cord compression Patient safety,effectiveness,and prognostic factors.The quality of life of patients with spinal cord compression in non-small cell lung cancer with spinal metastases was evaluated by the Chinese-style SOSG-QO spine metastases quality of life questionnaire.The efficacy of the operation was evaluated.RESULTS In a microwave ablation experiment of high-level solid tumors in vitro,the shape of the microwave ablation zone was ellipsoid,short-axis/longaxis ratio range at four power settings(40,60,80,and 100 W for 10 minutes).It is 0.80 ~ 0.88.The short axis diameters of the 40,60,80,and 100 W groups are 28.2 ± 1.1 mm,35.6 ± 1.3 mm,40.6 ± 1.6 mm,and 46.4 ± 1.7 mm,respectively;the long axes are 33.4 ± 1.5 mm,41.4 ± 1.7 mm,and 47.6,respectively.±1.8 mm and 54.2±2.1 mm.Overall,the temperature of the three points from the antennas 10,20 and 30 mm increases with increasing ablation time.Conventional histological analysis revealed tissue fixation in the ablation zone.At the 10 mm,20 mm position,higher microwave ablation power tends to produce higher temperatures,even exceeding 60 °C.For the 30 mm position(except 100W),at the end of the ablation,the different ablation powers eventually produce a similar temperature(about 47 ° C);at 100 W output power,the temperature at the t3 position can eventually reach 60 ° C.Morphological changes of tumor cells in the ablated region were observed by HE staining.Tumor cells before microwave ablation(Fig.4A)showed clear cytoplasm and diffuse or nested distribution.Tumor cells after microwave ablation(Fig.4B),the contours of tumor cells were blurred,the cytoplasm was red stained,and the nucleus was dissolved and condensed.In the clinical retrospective analysis,61 patients were included,including 41 males and 20 females;37 of them underwent spinal decompression and internal fixation,and 24 underwent microwave ablation combined with spinal decompression and internal fixation.A total of 34 patients(about 55.7%)had symptoms of spinal cord compression in the spine metastases before surgery.They were treated in our department.No chemotherapy was performed before surgery.The pathological evidence was confirmed to be derived from non-small cell lung cancer.The most common site of spinal cord compression is located in the thoracic vertebrae,accounting for 72.1%.There was a statistically significant difference between the two groups in the microwave ablation group and the control group except for the preoperative ASIA grade and the surgical classification.The difference of the other indicators was not statistically significant.During the mean follow-up time of 15.8(0.1-62)months,the 1-,2-,and 3-year survival rates of the microwave ablation group and the control group were 66.7% and 51.4%,33.3%,and 24.3%,8.3%,and 13.5%,respectively.The 1-,2-,and 3-year survival rates of all patients were 57.3%,27,9%,and 11.5%,respectively.The median survival time of all patients was 14 months.Univariate log-rank test was used to compare preoperative response to chemotherapy,preoperative dysfunction of walking disorder,postoperative chemotherapy,and whether postoperative drug use was associated with patient survival.These four indicators were analyzed by COX regression for multivariate analysis.Preoperative chemotherapy response to chemotherapy was performed.Whether oral targeted drugs and preoperative walking disorder were evaluated as independent influencing factors for survival prognosis.The risk of death in the PD group as the baseline group,SD group,PR group and non-chemotherapy group was lower than that in the baseline group PD group.The survival prognosis of the PD group was poor.Postoperative chemotherapy and postoperative oral targeted drugs were prognosis.Protective factors,patients with a walking disability rating of non-walking patients have a poor prognosis for survival.During the postoperative observation period,6 patients in the microwave ablation group had postoperative complications,the incidence of complications was 25%,including 3 cases of pneumonia,1 case of pneumonia complicated with pleural effusion,and 2 cases of nerve injury(1 of them)There were 9 cases of complications in the control group,and the complication rate was 24.3%,including 8 cases of pneumonia(1 case of severe pneumonia caused by pulmonary embolism,4 cases of pleural effusion).One patient developed postoperative pulmonary embolism;however,the difference between the two groups was not statistically significant.Intraoperative microwave ablation due to additional microwave ablation time resulted in prolonged operative time compared with the control group,and the difference was statistically significant.Moreover,compared with the control group,the microwave ablation group had less intraoperative blood loss and shorter postoperative discharge time.It can be seen from the pain score that the pain scores in the microwave treatment group and the control group were significantly improved compared with the preoperative ones,and the pain improvement degree in the microwave treatment group was significantly higher than that in the control group one week after the operation.In the analysis of quality of life,through the SOSG-QO spine metastases patient quality of life questionnaire,and to assess the coverage,accuracy,reliability,and validity of the questionnaire,it is found that the Chinese questionnaire can be better Assess the quality of life of patients with spinal metastases.To evaluate the quality of life of patients undergoing microwave ablation surgery before and after surgery,it was found that active surgical intervention can effectively improve the quality of life of patients,and combined microwave ablation can improve the quality of life of patients better than spinal decompression and internal fixation.Conclusion Under the safe and effective protection method,microwave ablation combined with spinal decompression and internal fixation for the treatment of spinal cord compression in patients with non-small cell lung cancer with spinal metastases is effective and can improve the quality of postoperative survival. |
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