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Background: The aim of the study was to explore the outcomes of computed tomography‐guided microwave ablation (MWA) in non‐small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI), and to compare the outcomes of ALI‐NSCLC and non‐ALI NSCLC patients after MWA. Methods: A total of 319 NSCLC patients and 366 tumors treated with MWA were included in the study, comprising 34 ALI‐NSCLC patients and 285 non‐ALI NSCLC patients. Complications, local recurrence rates, progression‐free survival (PFS), and overall survival (OS) were compared. Logistic regression analyses were used to investigate the correlation between ALI and the occurrence of pneumothorax after MWA. Results: The mean tumor diameter of ablated tumors was 3.6 ± 2.2 cm. There were 95 (29.8%) NSCLC patients in which pneumothorax occurred after MWA, and all patients recovered. Of these, the ALI group had a significantly higher incidence rate of pneumothorax than the non‐ALI group (52.9% vs. 27.0%, p = 0.002). The median PFS and OS for the ALI group were 12.0 ± 10.2 and 15.5 ± 9.5 months, respectively, and that of the non‐ALI group were 13.0 ± 10.6 and 17.0 ± 11.1 months, respectively, and no significant difference was found in PFS (p = 0.329) nor OS (p = 0.394) between the two groups. Local recurrence rates for ALI and non‐ALI groups were 29.4% and 20.7%, respectively, and no significant difference was found (p = 0.244). Logistic regression analyses revealed that ALI can increase the risk of pneumothorax (hazard ratio [HR], 2.867; p = 0.012). Conclusions: MWA is an effective and safe approach for ALI‐NSCLC treatment. Although ALI can increase the risk of pneumothorax, ALI‐NSCLC patients reveal a comparable outcome to non‐ALI NSCLC patients after MWA. [ABSTRACT FROM AUTHOR]

To develop effective nomograms for predicting pneumothorax and delayed pneumothorax after microwave ablation (MWA) in lung malignancy (LM) patients. LM patients treated with MWA were randomly allocated to a training or validation cohort at a ratio of 7:3. The predictors of pneumothorax identified by univariate and multivariate analyses in the training cohort were used to develop a predictive nomogram. The C-statistic was used to evaluate predictive accuracy in both cohorts. A second nomogram for predicting delayed pneumothorax was developed and validated using identical methods. A total of 552 patients (training cohort: n = 402; validation cohort: n = 150) were included; of these patients, 27.9% (154/552) developed pneumothorax, with immediate and delayed pneumothorax occurring in 18.8% (104/552) and 9.1% (50/552), respectively. The predictors selected for the nomogram of pneumothorax were emphysema (hazard ratio [HR], 6.543; p <.001), history of lung ablation (HR, 7.841; p=.025), number of pleural punctures (HR, 1.416; p <.050), ablation zone encompassing pleura (HR, 10.225; p <.001) and pulmonary fissure traversed by needle (HR, 10.776; p <.001). The C-statistics showed good predictive performance in the training and validation cohorts (0.792 and 0.832, respectively). Another nomogram for delayed pneumothorax was developed based on emphysema (HR, 2.952; p=.005), ablation zone encompassing pleura (HR, 4.915; p <.001) and pulmonary fissure traversed by needle (HR, 4.348; p =.015). The C-statistics showed good predictive performance in the training cohort, and it had efficacy for prediction in the validation cohort (0.719 and 0.689, respectively). The nomograms could effectively predict the risk of pneumothorax and delayed pneumothorax after MWA. [ABSTRACT FROM AUTHOR]