Liu Shupeng, Qin Zilin, Xu Jiongyuan, Zeng Jianying, Chen Jibing, Niu Lizhi, Xu Meng
Department of Oncology, Fuda Cancer Hospital, Jinan University, Guangzhou 510665, China,
Department of Oncology, First Affiliated Hospital of Jinan University, Guangzhou 510630, China,
Onco Targets Ther. 2019 Feb 18;12:1341-1350. doi: 10.2147/OTT.S186721. eCollection 2019.
We aimed to determine the safety and efficacy of irreversible electroporation (IRE) combined with chemotherapy for unresectable pancreatic carcinoma (stage III/IV).
We prospectively enrolled 54 patients (30 men; median age 61.0 years; range 41-73 years) undergoing IRE with or without chemotherapy for pancreatic cancer between July 2015 and August 2016. Kaplan-Meier estimates were used to analyze progression-free survival (PFS) and overall survival (OS). Safety was assessed based on the occurrence of adverse events.
All patients successfully underwent IRE. Major IRE-related complications were observed in four patients (7.4%). Gastrointestinal hemorrhage only developed in cases undergoing IRE via the open method, and was successfully managed with interventional embolization and/or vascular ligation. Any minor complications in the cases were alleviated within 14 days after symptomatic treatment. Overall, the performance status score decreased from 1.06 to 0.89 at 3 months after IRE (<0.05). Among those with stage III disease, after a median follow-up of 18.8 months (range 9.6-28.7 months), the median OS from diagnosis was 16.2 and 20.3 months in the IRE and IRE + Chemo groups, respectively. Among those with stage IV disease, after a median follow-up of 13.3 months (range 3.7-23.1 months), the median OS from diagnosis was 11.6 and 13.56 months in the IRE and IRE + Chemo groups, respectively. The OS was significantly poorer in the IRE group than in the IRE + Chemo group (log-rank test, =0.0398).
Patients with pancreatic carcinoma could benefit from IRE, which improved the OS in certain patients who had also undergone chemotherapy. Although some severe complications were noted, IRE was generally well tolerated.
我们旨在确定不可逆电穿孔（IRE）联合化疗治疗不可切除胰腺癌（III/IV期）的安全性和有效性。
我们前瞻性纳入了2015年7月至2016年8月期间接受IRE治疗（无论是否联合化疗）的54例胰腺癌患者（30例男性；中位年龄61.0岁；范围41 - 73岁）。采用Kaplan-Meier估计法分析无进展生存期（PFS）和总生存期（OS）。根据不良事件的发生情况评估安全性。
所有患者均成功接受了IRE治疗。4例患者（7.4%）出现了与IRE相关的主要并发症。胃肠道出血仅发生在通过开放手术进行IRE的病例中，通过介入栓塞和/或血管结扎成功处理。病例中的任何轻微并发症在对症治疗后14天内得到缓解。总体而言，IRE治疗后3个月时，患者的体能状态评分从1.06降至0.89（<0.05）。在III期疾病患者中，中位随访18.8个月（范围9.6 - 28.7个月）后，IRE组和IRE + 化疗组从诊断开始的中位OS分别为16.2个月和20.3个月。在IV期疾病患者中，中位随访13.3个月（范围3.7 - 23.1个月）后，IRE组和IRE + 化疗组从诊断开始的中位OS分别为11.6个月和13.56个月。IRE组的OS明显低于IRE + 化疗组（对数秩检验，=0.0398）。
胰腺癌患者可从IRE中获益，IRE改善了部分接受过化疗患者的OS。尽管注意到了一些严重并发症，但IRE总体耐受性良好。
