聚焦超声消融治疗老年进展期胰腺癌的临床研究

Focused ultrasound ablation in elderly patients with advanced pancreatic cancer:a clinical research

目的：初步评估聚焦超声消融（ FUA ）治疗≥60岁进展期胰腺癌患者的疗效、安全性及生存影响因素。方法回顾性地分析军事医学科学院附属医院2010年9月至2015年9月期间应用IC型高强度聚焦超声系统治疗的≥60岁进展期胰腺癌患者的临床资料，评价局部消融疗效、癌痛缓解情况及并发症，统计总体生存率（OSR）及中位生存时间（MST），初步分析影响MST的主要因素。结果44例患者行47次FUA治疗，完全缓解（CR）6．8％（3／44），部分缓解（PR）77.2％（34／44），稳定（SD）13．6％（6／44），进展（PD）2．3％（1／44）。疼痛缓解率为97.4％（38／39），术后疼痛评分显著下降（P＜0.001）。Ⅲ期、Ⅳ期患者MST分别为16．5个月（6.1～51.0个月）、9.8个月（3.0～24.4个月）；第1年、2年 OSR分别为62.9％、21.0％和39.1％、4.3％。并发症总体发生率为50.0％（22／44），95.5％（21／22）为轻度，未出现严重并发症。 Cox比例风险回归模型结果显示影响MST的主要因素为临床分期、消融疗效及是否联合治疗，其中联合化疗和放疗的Ⅲ期患者的MST达到24.2个月。结论 FUA可以治疗中老年进展期胰腺癌，局部有效率较高，能明显缓解疼痛并延长生存时间，并发症可控，值得深入研究。

Objective To evaluate the efficacy , safety and survival influencing factors of focused ultrasound ablation （ FUA ） in elderly patients with advanced pancreatic cancer （aged more than 60 years）.Methods Clinical data of the patients over 60 years old with advanced pancreatic cancer admitted in Affiliated Hospital to Academy of Military Medical Sciences from September 2010 to September 2015 were retrospectively collected and analyzed.They were all treated with a JC high intensity focused ultrasound （HIFU） system.The local ablation efficacy , pain relief and occurrence of complications were evaluated .The overall survival rate （ OSR） and median survival time （ MST） were statistically analyzed.The main factors affecting MST were analyzed .Results The obtained 44 patients received totally 47 treatments of FUA.The patients who achieved complete response （CR） accounted for 6.8% （3/44）, partial response （PR） for 77.2% （34/44）, stable condition （SD） for 13.6% （6/44）, and progress condition （PD） for 2.3%（1/44）.The pain relief rate was 97.4%（38/39）, with the pain scores decreased significantly postoperatively （P〈0.001）.For the patients with stage Ⅲand Ⅳpancreatic cancer , the MST were 16.5 （6.1-51） and 9.8 （3-24.4） months, and the 1-and 2-year cumulative survival rates were 62.9%and 21.0%, and 39.1%and 4.3%, respectively.The overall incidence of complications was 50.0%（22/44）, among which 95.5% （21/22） were mild complications, and no severe complication was seen .Cox multivariate analysis indicated that the main factors affecting prognosis were clinical stage , ablation efficacy and combination treatment .The MST reached to 24.2 months in the patients with stage Ⅲ who combined chemotherapy and radiotherapy .Conclusion FUA is a good option for advanced pancreatic cancer in the elderly patients , with better efficacy of local ablation , obvious pain relief , and prolonged survival time.The complications can be controlled .It is worth of further study .