Clinical Lab, The Third People's Hospital of Datong, Datong, People's Republic of China.
Department of Gastroenterology, The Second People's Hospital of Datong Cancer Hospital, Datong, People's Republic of China.
J Ultrasound Med. 2023 Jul;42(7):1595-1607. doi: 10.1002/jum.16181. Epub 2023 Jan 24.
This retrospective study was conducted to assess the efficacy and safety of high intensity focused ultrasound (HIFU) in combination with chemotherapy compared with chemotherapy alone in treating patients with unresectable locally advanced pancreatic cancer (LAPC).
The data of unresectable LAPC patients who received chemotherapy with or without HIFU ablation were retrieved retrospectively. The overall survival (OS), objective response rate (ORR), cancer antigen 19-9 response rate, and safety were compared between these two groups before and after propensity score matching (PSM).
Overall, 254 patients with LAPC were included, of whom 92 underwent HIFU ablation. After PSM to control for potential biases, HIFU was associated with improved OS (12.8 versus 12.2 months, log-rank P = .046), as compared to patients without HIFU ablation. Patients with numeric rating scale (NRS) less than 4, and receiving HIFU ablation were significantly associated with improved OS (adjusted hazard ratio [aHR] = 0.365 [95% confidence interval (CI) = 0.148-0.655], P = .002; aHR = 0.490 [95% CI = 0.250-0.961], P = .038; respectively) by multivariate analyses with the adjustment of age, NRS, and tumor size. ORR was also observed to be higher in HIFU group of 30.0% than in the chemotherapy group of 13.3% (P = .039). No severe adverse events of special interest or HIFU-caused deaths were observed.
Patients with unresectable LAPC who received gemcitabine-based chemotherapy might benefit from additional HIFU ablation.
本回顾性研究旨在评估高强度聚焦超声（HIFU）联合化疗与单纯化疗治疗不可切除局部晚期胰腺癌（LAPC）患者的疗效和安全性。
回顾性检索接受化疗联合或不联合 HIFU 消融治疗的不可切除 LAPC 患者数据。比较两组患者在倾向评分匹配（PSM）前后的总生存期（OS）、客观缓解率（ORR）、癌抗原 19-9 缓解率和安全性。
共有 254 例 LAPC 患者纳入研究，其中 92 例接受 HIFU 消融治疗。经 PSM 控制潜在偏倚后，与未接受 HIFU 消融治疗的患者相比，HIFU 治疗组的 OS 改善（12.8 个月 vs. 12.2 个月，log-rank P=0.046）。NRS 评分<4 分且接受 HIFU 消融治疗的患者 OS 明显改善（调整后 HR=0.365 [95%CI 0.148-0.655]，P=0.002；HR=0.490 [95%CI 0.250-0.961]，P=0.038），多变量分析中调整了年龄、NRS 和肿瘤大小。HIFU 组的 ORR 也高于化疗组（30.0% vs. 13.3%，P=0.039）。未观察到严重不良事件或与 HIFU 相关的死亡。
接受吉西他滨为基础化疗的不可切除 LAPC 患者可能从额外的 HIFU 消融中获益。
