Safety of Percutaneous Thermal Ablation of Lung Tumours in Pulmonary Hypertension.

OBJECTIVES

To compare the safety profile of percutaneous thermal ablation of lung tumours in patients with and without pulmonary hypertension (PH).

METHODS

This retrospective bi-institutional cohort study included consecutive adults who underwent microwave or cryoablation of lung tumours (primary lung cancer, metastases) from 2/2015 to 10/2024. The presence of PH was determined by right heart catheterization, transthoracic echocardiography, or chest computed tomography. We compared patients with vs without PH regarding major adverse events (Common Terminology Criteria for Adverse Events ≥grade 3) within 30 days, hospital length of stay ≥2 days, haemorrhagic events, and 90-day mortality using logistic regression, and overall survival using log-rank test.

RESULTS

Overall, 310 patients (50 patients with PH, 260 patients without PH; 58% females; median age 65 years) underwent 512 ablation sessions targeting 741 lung tumours (83% metastases). Patients with PH had higher Eastern Cooperative Oncology Group and Charlson comorbidity scores (median 1 vs 0, 9 vs 8; both P = 0.003). After adjusting for the number of ablation applicators inserted, ablation modality, and tumour location by lung zone, no significant difference was observed between patients with and without PH regarding major adverse events (14% vs 8%, OR = 1.98 [P = 0.07]), hospital length of stay (P = 0.72), haemorrhagic events (P =0.10), and 90-day mortality (P = 0.08). Overall survival was also not significantly different (P = 0.70).

CONCLUSIONS

We were unable to detect a difference in safety profile between patients with and without PH who underwent percutaneous thermal ablation of lung tumours. However, frequencies of adverse outcomes were numerically higher in patients with PH.