高强度聚焦超声治疗非手术胰腺癌近期疗效评价及生存分析

目的 探讨高强度聚焦超声（high intensity focused ultrasound, HIFU）治疗非手术胰腺癌近期疗效及生存情况。方法 筛选符合入组条件的非手术胰腺癌患者30例（3例患者共接受2次HIFU治疗，共计33例次），记录患者HIFU治疗前1周和治疗后1个月肿瘤标志物CA19-9和靶病灶影像学变化，对患者进行生存随访。结果 HIFU治疗后，靶病灶最大直径为（4.8±1.54）cm，与治疗前最大直径（4.67±1.50）cm相比，差异无统计学意义（P=0.328）；胰腺超声造影检查提示靶病灶区血供减少，CT增强检查示靶病灶区内密度降低，MRI增强检查示T1WI信号增加，T2WI信号降低；57.7%患者血清CA19-9降低。30例患者中位生存期10.4个月（95%CI： 7.93～12.8），6、12个月生存率分别为66.7%和20%。结论 HIFU治疗能够有效抑制肿瘤生长，减轻肿瘤负荷，延长胰腺癌患者的生存期，且不良反应少，是非手术胰腺癌患者的治疗方法之一。
Objective To evaluate the short-term efficacy and survival of patients with pancreatic cancer undergoing high-intensity focused ultrasound (HIFU). Methods Thirty patients with inoperable pancreatic cancer underwent 33 treatments of HIFU. The serum level of CA19-9, imaging findings and complications were recorded 1 month after HIFU treatment. The median survival time（MST）was calculated by Kaplan-Meier method. Results The maximum size of tumor was not significantly changed after HIFU treatment [before treatment (4.8±1.54) cm, after treatment (4.67±1.50) cm, P=0.472]. Imaging examination suggested that coagulation necrosis occurred in the target lesion and the blood supply was reduced or disappeared in the enhanced images; serum CA19-9 levels were decreased in 57.7％ patients. The medium survival time (MST) was 10.4 months(95%CI: 7.93-12.8); 6-month and 1-year survival rates were 66.7% and 20% respectively. Conclusion HIFU may benefit to advanced pancreatic cancer patient by stabilizing tumors, alleviating tumor burden and prolonging survival with less complications, which can be chosen as a palliative treatment in patients with inoperable pancreatic cancer