Clinical Study On The Correlation Between CT Value Changes And Prognosis Of Cold Ablation With Argon-helium Knife For Primary Lung Cancer

[Objective]This study aims to investigate the correlation between the CT value and the patients' survival time,and the patients should be diagnosed with primary lung cancer and treated with cryoablation;we need to contrast the smoking history,smoking cessation history,pulmonary disease history,treatment history,pathological type and TCM syndrome types,also obtain intraoperative CT value changes and the optimal CT value range after cryoablation in primary lung cancer with different pathological types and clinical stages,in order to provide guidance for cryoablation.[Methods]On the basis of previous theoretical and clinical research,this subject collects the original treatment of primary lung cancer cryoablation in the Department of Oncology,Oriental Hospital from May 2012 to March31,2018 through a single-center,retrospective clinical research method.We collect the clinical data of patients with primary lung cancer,and extract information of preoperative CT values,intraoperative CT values and immediate CT values.At last,we search for the correlation between CT value changes and survival,also carry out multivariate analysis.[Results]1.180 patients were included,a total of 210 cases.There were 59 patients with underlying lung disease and 81 patients with other diseases(diabetes,coronary heart disease,hypertension,hyperlipidemia,stroke).There was no significant difference in Barthel's score on admission and discharge,or on the first day before and the third day after cryoablation.Preoperative clinical stages were mostly stage ? and stage ? of NSCLC.The target lesions were located close to the visceral pleura in 158 cases,close to or compressed the mediastinum in 101 cases,close to the lung hilum in 89 cases,close to the bronchus in 91 cases,and close to the blood vessels in 122 cases.There were 67 cases of intraoperative complications and 182 cases of postoperative complications.2.Survival:The median DOS was 16.85 months after the first pathological diagnosis,the median COS was 9.6 months after the cryoablation,and the median PFS was 8.2 months.3.CT value3.1 Scan CT value:The edge of the tumors(31.35±13.75)HU,ice hockey center(34.37±15.13)HU,tumors(32.86±13.73)HU3.2Enhanced CT value:The edge of the tumors(54.84±21.69)HU,ice hockey center(51.63±18.82)HU,tumors(53.23±19.04)HU3.3The difference between plain CT value and enhanced CT value before cryoablation in tumor(23.00±14.65)HU3.4Intraoperative CT value changes:The edge of the tumors(15.77±23.13)HU,ice hockey center(37.38±24.07)HU,tumors(26.57±21.12)HU3.5The immediate CT value after cryoablation:The edge of the tumors(15.23±23.82)HU,ice hockey center(-3.64±21.25)HU,tumors(5.79±20.24)HU.4.CT value related factorsCT value was related to age group,smoking history,pathological type,preoperative clinical stage,preoperative lesion size group,postoperative complications,lesion anatomical structure,COS and PFS,and was not related to smoking cessation history,differentiation degree of NSCLC,preoperative TCM syndrome,intraoperative complications and lesion lobes.It is impossible to predict COS and PFS by the immediate CT value range after cryoablation.5.Factors related to survival5.1 Correlation factors with COS with statistical significance:smoking,lesion anatomy location,lesion size,pathological type,degree of differentiation,preoperative clinical stage,chemotherapy,targeted therapy,and hockey coverage;The correlation factors with PFS are statistically significant:smoking,lesion location,pathological type,degree of differentiation,preoperative clinical stage,chemotherapy,and hockey coverage.5.2Independent influencing factors(1)Pathological type,preoperative clinical stage,intraoperative CT value changes and the immediate postoperative CT value of the tumor edge are independent influencing factors for the COS of patients with lung adenocarcinoma and squamous cell carcinoma.The change of CT value in tumor during cryoablation was an independent factor affecting the COS of lung adenocarcinoma."Intraoperative CT value change of the tumor periphery"was the protective factor,and the risk decreased by 0.962 times for every 1 unit increase."The immediate CT value of tumor edge after cryoablation"was a risk factor,and the risk increased by 1.038times for every 1 unit.(2)Pathological type,preoperative clinical stage,intraoperative CT value change of the tumor edge,intraoperative CT value change of the ice hockey center,and postoperative CT value of the tumor edge are independent influencing factors of PFS in patients with lung adenocarcinoma and squamous cell carcinoma."Intraoperative CT value change of the tumor edge"was the protective factor,and the risk decreased by 0.967 times for every 1 unit increase."CT value change in ice hockey center"was a risk factor,and the risk increased by 1.009times for every 1 unit."The immediate CT value of tumor edge after cryoablation"was a risk factor,and the risk increased by 1.027 times for every 1 unit.(3)The immediate CT value of tumor edge after cryoablation was an independent risk factor of COS in SCLC patients,and the risk increased by 1.132 times for each unit increase.(4)Preoperative clinical staging and postoperative CT value of the ice hockey center were independent factors of PFS in SCLC patients."The immediate CT value of the ice hockey center after cryoablation"was a risk factor,and the risk increased by 1.089times for every 1 unit.6.Preoperative diagnosis of TCM syndromes showed that the largest group was lung and spleen deficiency,about 94 cases(44.8%),followed by 48 cases(22.9%)of Qi stagnation and blood stasis,and 29 cases(13.8%)of both Qi and Yin deficiency.In the preoperative syndrome,there were 166 cases of blood stasis(79%),165 cases of phlegm(79%)and 18 cases of toxin(9%),they were the main syndromes,and Qi deficiency(102 cases,49%)and Yin deficiency(57 cases,27%)were the main syndromes.[Conclusion](1)CT value was related to COS,PFS.It is impossible to predict COS and PFS by the immediate CT value range after cryoablation.(2)For the COS of lung adenocarcinoma,we need to retain the "protection area",moderately reduce the immediate CT value of tumor edge after cryoablation and also make the CT value of the whole tumor change between 30-40HU during cryoablation,so as to obtain a higher survival rate and a longer survival period possibly.While squamous cell carcinomas and SCLC:the COS survival rate was lower when the CT value of tumor during cryoablation changed between 30 and 40HU,and the>40HU group had a higher survival rate in SCLC.