Efficacy and safety of CT-guided microwave ablation for stage I non-small cell lung cancer in elderly patients.

Objective: To evaluate the efficacy of MWA for patients aged ≥ 75 years with stage I NSCLC, and to explore the impacts of age and comorbidities on the long-term outcomes.

Methods: Patients with stage I NSCLC underwent MWA between November 2016 and December 2020 were retrospectively enrolled. Patients were stratified into two cohorts: ≥ 75 years and < 75 years. Propensity score matching was implemented to control selection bias. Primary endpoints included overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Secondary endpoints included independent risk factors influencing OS.

Results: 138 patients were successfully matched, with 69 in each group. The 1-, 3-, and 5-year OS were 95.7%, 82.6%, and 72.8% in patients aged ≥ 75 years, while 97.1%, 89.9%, and 80.3% in younger patients. There was no significant difference (p = 0.212). The 1-, 3-, and 5-year CSS were 100.0% vs. 98.6%, 92.2% vs. 92.6%, and 83.6% vs. 89.2%, respectively. No significant difference was observed (p = 0.661). The 1-, 3-, and 5-year RFS were 82.1% vs. 88.4%, 60.6% vs. 63.3%, and 58.9% vs. 61.6% without significant difference (p = 0.537). The multivariate COX analysis showed age and Charlson comorbidity index (CCI) were not prognostic factors. Idiopathic pulmonary fibrosis (IPF)/chronic obstructive pulmonary disease (COPD) was an independent risk factor (95% CI 1.32-8.24; p = 0.011).

Conclusion: MWA is an efficacious tool for patients aged ≥ 75 years with NSCLC. There are no significant differences in efficacy compared with younger patients. Age and CCI are not significant factors associated with prognosis, while IPF/COPD is an independent risk factor.