Application Of Focused Ultrasound Ablation In The Treatment Of Stage Ⅲ/Ⅳ Pancreatic Cancer And The Establishment Of A Prognostic Model

Objective To explore the applicability of focused ultrasound ablation(FUA)in the treatment of stage Ⅲ/Ⅳ pancreatic cancer and the prognostic factors by analyzing the clinical data.Then build a preliminary prognostic model.Methods The clinical data on 102 patients with stage Ⅲ/Ⅳ pancreatic cancer admitted to the department of minimally invasive oncology,the Fifth Medical Center of the PLA General Hospital between January 2010 and May 2020 was retrospectively analyzed,including 40 patients with stage Ⅲ and 62 patients with stage Ⅳ.To analyze the cancer pain relief rate,local efficacy,and adverse reactions of FUA treatment.The factors affecting overall survival such as the timing of FUA treatment,the chemotherapy route,and the degree of tumor differentiation were also analyzed.Put the data such as gender,age,tumor size,tumor location,some immune inflammation indicators and treatment grouping factors into the survival analysis.Put the independent prognostic factors into the analysis,then build a prognostic model and evaluate the accuracy of the model by using R software.Results(1)The cancer pain score decreased significantly after FUA treatment,and the cancer pain relief rate was 87.84%.The objective response rate of local tumors was78.75%,and the disease control rate was 92.50%.The most common complications of FUA treatment were pain,skin burns in the treated areas and nausea symptoms,but no serious complications of grade E and F occurred.(2)It has not been proved that the sequence of FUA treatment and chemotherapy,the chemotherapy routes,and the degree of tumor differentiation have a significant impact on the overall survival of advanced pancreatic cancer.(3)The median overall survival time of patients with stage Ⅲ was 11.9 months,the 6-month,12-month,and 18-month survival rates were 95.0%,40.0%,and 12.5%,respectively.The results of multivariate analysis showed that CA19-9(P=0.010)and treatment groups(P=0.042)were independent prognostic factors.The prognosis of patients with CA19-9<500U/m L was significantly better than that with CA19-9≥500U/m L.The prognosis of patients treated with FUA combined with chemotherapy was significantly better than that treated with FUA alone.(4)The median overall survival time of patients with stage Ⅳ was 7.2 months,the6-month,12-month,and 18-month survival rates were 59.4%,21.0%,and 4.8%,respectively.The results of multivariate analysis showed that CA19-9(P=0.001),Glasgow prognostic score(GPS)(P=0.008)and treatment groups(P=0.010)were independent prognostic factors.The prognosis of patients with CA19-9<1000 U/m L was significantly better than that with CA19-9≥1000 U/m L.The prognosis of patients with GPS of 0 and 1 was significantly better than that with GPS of 2.The prognosis of patients treated with FUA combined with chemotherapy was significantly better than that treated with FUA alone and chemotherapy alone.(5)The C index of the prognostic model for patients with stage Ⅳ was 0.72(95% CI:0.66～ 0.79).Conclusion FUA treatment can safely and significantly alleviate the pain caused by advanced pancreatic cancer.It can also inhibit the growth of tumors.The overall survival time of patients treated with FUA combined with chemotherapy was significantly longer than that of patients treated with FUA alone or chemotherapy alone.CA19-9≥500U/m L was a poor prognostic factor for patients with stage Ⅲ.CA19-9≥1000U/m L and GPS of 2 were poor prognostic factors for patients with stage Ⅳ.