不可逆电穿孔和转化手术切除治疗局部进展期胰腺癌的效果比较

Comparison of the efficacy of irreversible electroporation and conversional resection for locally advanced pancreatic cancer

目的比较不可逆电穿孔(IRE)与转化手术切除治疗局部进展期胰腺癌(LAPC)的近期和远期效果。方法回顾性收集2015年8月至2020年12月在中山大学附属肿瘤医院胰胆外科接受治疗的98例LAPC患者的临床和病理学资料。男性53例,女性45例,年龄[M(IQR)]57.5(13.5)岁(范围:20~87岁)。其中接受IRE治疗(IRE组)53例,接受转化手术切除(转化手术组)45例。两组患者一般资料的差异均无统计学意义(P值均>0.05)。定量资料的比较采用Mann-Whitney U检验;分类资料的比较采用χ^(2)检验;总体生存(OS)和肿瘤无进展生存(PFS)的生存分析采用Kaplan-Meier法,并通过Log-rank检验进行比较。结果IRE组的手术时间和术中出血量分别为5.0(2.4)h和50(100)ml,低于转化手术组[7.0(3.3)h和400(200)ml](P值均<0.05)。IRE组的术后住院时间和住院费用分别为9.0(3.0)d和79154(83738)元,亦低于转化手术组[16.0(8.5)d和109557(37795)元](P值均<0.05)。IRE组术后并发症发生率低于转化手术组(18.8%比55.6%,χ^(2)=14.270,P<0.01)。IRE组患者中位OS时间为28.9个月(95%CI:23.2~34.6),1、2、3年OS率分别为91.6%、61.7%、24.6%;转化手术组患者中位OS时间为27.1个月(95%CI:20.9~33.3),1、2、3年OS率分别为81.8%、53.9%、30.3%;两组差异无统计学意义(χ^(2)=0.900,P=0.760);IRE组患者中位PFS时间为18.0个月(95%CI:14.7~21.3),1、2、3年PFS率分别为68.3%、29.7%、9.9%;转化手术组患者中位PFS时间为11.1个月(95%CI:6.1~16.2),1、2、3年PFS率分别为45.2%、21.9%、14.6%;两组差异无统计学意义(χ^(2)=1.850,P=0.170)。结论IRE能使LAPC患者取得与转化手术切除类似的生存时间,且术后并发症较少。

Objective To compare the short-term and long-term prognosis of irreversible electroporation(IRE)and conversional resection for locally advanced pancreatic cancer(LAPC).Methods The clinical and pathological data of 98 LAPC patients who underwent IRE or conversional resection at the Department of Pancreatobiliary Surgery,Sun Yat-sen University Cancer Center from August 2015 to December 2020 were retrospectively collected and analyzed.The study comprised of 53 males and 45 females,with age(M(IQR))of 57.5(13.5)years old(range:20 to 87 years old).Fifty-three patients received IRE treatment(IRE group)and 45 patients received surgical resection(resection group).The differences of clinical and pathological data between both groups were not significant(all P<0.05).The Mann-Whitney U test was used for quantitative data and theχ^(2)test was used for categorical data.Survival was analyzed using Kaplan-Meier method and compared using Log-rank test.Results The operation time and intraoperative blood loss were 5.0(2.4)hours and 50(100)ml in the IRE group,respectively,which were significantly less than those of resection group(7.0(3.3)hours and 400(200)ml,both P<0.05).The hospital stay and hospitalization cost were 9.0(3.0)days and 79154(83738)yuan in the IRE group,respectively,which were also significantly less than those in the resection group(16.0(8.5)days and 109557(37795)yuan,both P<0.05).The complication rate of IRE group was significantly lower than that of the resection group(18.8%vs.55.6%,χ^(2)=14.270,P<0.01).The median overall survival(OS)time of IRE group was 28.9 months(95%CI:23.2 to 34.6 months),with the 1-,2-,and 3-year OS rates of 91.6%,61.7%,and 24.6%,respectively.The median survival of OS of resection group was 27.1 months(95%CI:20.9 to 33.3 months),with the 1-,2-,and 3-year OS rates of 81.8%,53.9%,and 30.3%,respectively.There was no significant difference in OS between the two groups(χ^(2)=0.900,P=0.760).The median progression free survival(PFS)time of IRE group was 18.0 months(95%CI:14.7 to 21.3 months),with the 1-,2-,and 3-year PFS rates of 68.3%,29.7%,and 9.9%,respectively.The median survival of PFS of resection group was 11.1 months(95%CI:6.1 to 16.2 months),with the 1-,2-,and 3-year PFS rates of 45.2%,21.9%,and 14.6%,respectively.There was no significant difference in PFS between the two groups(χ^(2)=1.850,P=0.170).Conclusion IRE can achieve similar survival for LAPC and may has less complications compared to those with conversion resection.