Ning Zhou-Yu, Cheng Chien-Shan, Xie Jing, Chen Qi-Wen, Xu Li-Tao, Zhuang Li-Ping, Zhang Chen-Yue, Song Li-Bin, Shi Wei-Dong, Zhu Xiao-Yan, Wang Peng, Wang Kun, Meng Zhi-Qiang
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
These authors contributed equally to this work.
Discov Med. 2016 Jun;21(118):435-45.
To retrospectively evaluate possible impact factors of HIFU treatment outcome for unresectable pancreatic cancer patients.
A total of 689 patients with unresectable pancreatic cancer were recruited in our center from December 30, 2007 to January 30, 2015. 436 patients with unresectable pancreatic cancers received HIFU treatment; the other 253 patients received non-HIFU treatment. Among these 436 patients, 345 patients received a one-time HIFU treatment, 91 patients received HIFU treatment from 2 to 5 times in the same pancreatic mass; 89 patients received HIFU treatment alone; 347 patients received HIFU-based combined therapies. Complications and overall survivals (OS) data in each group were collected.
The median overall survivals (mOS) in HIFU group and non-HIFU group were 7.1 vs. 5 months (P=0.005): 9.3 vs. 7.3 months (P=0.202) for patients with stage II disease, 8.3 vs. 7.3 months (P=0.783) for patients with stage III disease, and 6.4 vs. 4.2 months (P<0.0001) for patients with stage IV disease, respectively. Furthermore, there was a significant difference between repeated HIFU and one-time HIFU (mOS: 8.6 vs. 6.8 months, P=0.011). Time of HIFU treatment (P=0.0027), chemotherapy (P<0.0001), radiotherapy (P=0.0006), regional intra-arterial chemotherapy (RIAC) (P<0.0001), and stage (P<0.0001) were independent prognostic factors for the patients who received HIFU treatment. Cox analysis on the relative risk of prognostic factors showed that repeated HIFU vs. one-time HIFU (HR=0.729: 95% CI=0.576-0.924), chemotherapy vs. non-chemotherapy (HR=0.664: 95% CI=0.576-0.766), radiotherapy vs. non-radiotherapy (HR=0.580: 95% CI=0.427-0.789), RIAC vs. non-RIAC (HR=0.737: 95% CI=0.648-0.837), and stage (HR=1.386, 95% CI=1.187-1.619) were associated with significantly inferior survival. Overall, adverse events occurred in 23.2% (101/436) in the HIFU group, which included increase of serum or urinary amylase levels, incomplete intestinal obstruction, mild fever, etc. There were no severe adverse events such as skin burns or GI perforation related to HIFU therapy in any of the patients treated.
This retrospective analysis revealed that the use of a multimodal treatment approach (the combined therapy of HIFU, RIAC, and chemotherapy, with or without radiotherapy) could improve survival of patients with unresectable pancreatic cancer, and repeated HIFU presented a survival benefit and did not increase risk.
回顾性评估不可切除胰腺癌患者高强度聚焦超声（HIFU）治疗效果的可能影响因素。
2007年12月30日至2015年1月30日，本中心共纳入689例不可切除胰腺癌患者。436例不可切除胰腺癌患者接受了HIFU治疗；另外253例患者接受了非HIFU治疗。在这436例患者中，345例患者接受了一次性HIFU治疗，91例患者在同一胰腺肿块接受了2至5次HIFU治疗；89例患者仅接受HIFU治疗；347例患者接受了以HIFU为基础的联合治疗。收集每组的并发症和总生存期（OS）数据。
HIFU组和非HIFU组的中位总生存期（mOS）分别为7.1个月和5个月（P = 0.005）：II期疾病患者为9.3个月和7.3个月（P = 0.202），III期疾病患者为8.3个月和7.3个月（P = 0.783），IV期疾病患者为6.4个月和4.2个月（P < 0.0001）。此外，重复HIFU和一次性HIFU之间存在显著差异（mOS：8.6个月和6.8个月，P = 0.011）。HIFU治疗时间（P = 0.0027）、化疗（P < 0.0001）、放疗（P = 0.0006）、区域动脉内化疗（RIAC）（P < 0.0001）和分期（P < 0.0001）是接受HIFU治疗患者的独立预后因素。对预后因素相对风险的Cox分析表明，重复HIFU与一次性HIFU（HR = 0.729：95%CI = 0.576 - 0.924）、化疗与非化疗（HR = 0.664：95%CI = 0.576 - 0.766）、放疗与非放疗（HR = 0.580：95%CI = 0.427 - 0.789）、RIAC与非RIAC（HR = 0.737：95%CI = 0.648 - 0.837）以及分期（HR = 1.386，95%CI = 1.187 - 1.619）与生存期显著较差相关。总体而言，HIFU组23.2%（101/436）发生了不良事件，包括血清或尿淀粉酶水平升高、不完全肠梗阻、低热等。在接受治疗的任何患者中，均未发生与HIFU治疗相关的严重不良事件，如皮肤烧伤或胃肠道穿孔。
这项回顾性分析表明，采用多模式治疗方法（HIFU、RIAC和化疗联合治疗，联合或不联合放疗）可提高不可切除胰腺癌患者的生存率，重复HIFU具有生存获益且不增加风险。
