一项针对局部进展期胰腺腺癌不可逆电穿孔治疗的前瞻性、多机构评估：AHPBA 胰腺登记处的初步结果。
A prospective, multi-institution assessment of irreversible electroporation for treatment of locally advanced pancreatic adenocarcinoma: initial outcomes from the AHPBA pancreatic registry.
机构信息
University of Louisville, Hiram C. Polk Jr, MD Department of Surgery, Division of Surgical Oncology, Louisville, KY, USA.
Augusta University Medical Center, Department of Surgery, Section of Surgical Oncology, Augusta, GA, USA.
出版信息
HPB (Oxford). 2019 Aug;21(8):1024-1031. doi: 10.1016/j.hpb.2018.12.004. Epub 2019 Feb 5.
BACKGROUND
The optimal treatment and management of locally advanced pancreatic cancer (LAPC) remains unclear and controversial. This study aimed to report the initial outcomes of the AHPBA Registry and evaluate the reproducibility of existing evidence that the addition of Irreversible Electroporation (IRE), a nonthermal ablative treatment, confers survival benefits beyond standard therapeutic options for patients with LAPC.
METHODS
From December 2015 to October 2017, patients with LAPC were treated with open-technique IRE following the AHPBA Registry Protocols. Patient demographics, long-term outcomes, and adverse events were recorded. Survival analyses were performed using Kaplan-Meier (KM) curves for overall survival (OS), progression free survival (PFS) and time to progression (TTP).
RESULTS
A total of 152 patients underwent successful IRE. Morbidity and mortality were 18% and 2% respectively, with 19 (13%) patients experiencing severe adverse events. Nine (6%) patients presented with local recurrence. Median TTP, PFS, and OS from diagnosis were 27.3 months, 22.8 months, and 30.7 months respectively.
CONCLUSION
The combination of IRE with established multiagent therapy is safe and demonstrates encouraging survival among patients with LAPC. IRE is associated with a low rate of serious adverse events and has been optimized for more widespread adoption through the standardized protocols available through the AHPBA registry.
背景
局部晚期胰腺癌（LAPC）的最佳治疗和管理仍不清楚且存在争议。本研究旨在报告 AHPBA 注册中心的初步结果，并评估现有证据的重现性，即添加不可逆电穿孔（IRE）作为一种非热消融治疗方法，是否为 LAPC 患者提供了超越标准治疗选择的生存获益。
方法
从 2015 年 12 月至 2017 年 10 月，根据 AHPBA 注册中心的协议，对 LAPC 患者采用开放式 IRE 技术进行治疗。记录患者的人口统计学特征、长期结局和不良事件。使用 Kaplan-Meier（KM）曲线进行总体生存（OS）、无进展生存（PFS）和进展时间（TTP）的生存分析。
结果
共有 152 例患者成功接受了 IRE 治疗。发病率和死亡率分别为 18%和 2%，19 例（13%）患者出现严重不良事件。9 例（6%）患者出现局部复发。从诊断开始的中位 TTP、PFS 和 OS 分别为 27.3 个月、22.8 个月和 30.7 个月。
结论
IRE 联合标准的多药治疗是安全的，并在 LAPC 患者中显示出令人鼓舞的生存获益。IRE 与严重不良事件的低发生率相关，并通过 AHPBA 注册中心提供的标准化协议得到了优化，以便更广泛地采用。
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