Abstract 1169
Background
Locally advanced pancreatic cancer (LAPC) represents more than one third of pancreatic cancers and owns poor survival after the standard chemotherapy. Irreversible electroporation (IRE) is a novel method and has been recently used in LAPC. The aim of this study was to compare the efficacy of IRE combined with chemotherapy and chemotheraoy alone for patients with LAPC.
Methods
Locally advanced pancreatic cancer (LAPC) represents more than one third of pancreatic cancers and owns poor survival after the standard chemotherapy. Irreversible electroporation (IRE) is a novel method and has been recently used in LAPC. The aim of this study was to compare the efficacy of IRE combined with chemotherapy and chemotheraoy alone for patients with LAPC.
Results
Before PSM analysis, patients with LAPC had better overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) after IRE combined with chemotherapy compared with chemotherapy alone (median OS, 16.0 months vs 8.0 months in SEER dataset, P < 0.001, 21.6 months vs 7.1 months in SYSUCC dataset, P = 0.006; median CSS, 18 months vs 8 months, P < 0.001; median PFS, 7.7 months vs 4.9 months, P = 0.001). Multivariate Cox regression analysis indicated that IRE combined with chemotherapy was identified as a significant prognostic factor for OS, CSS and PFS in LAPC patients of both the whole cohort and the matched cohort.Table: 703P
Univariate and multivariate analyses of OS in patients
| Characteristic | Before PSM | After PSM | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | ||||||||||
| HR | 95%CI | P | HR | 95%CI | P | HR | 95%CI | P | HR | 95% CI | P | ||
| SEER dataset | |||||||||||||
| Age (years) | ≤ 60 / > 60 | 1.295 | 1.193-1.406 | <0.001 | 1.281 | 1.180-1.391 | <0.001 | 1.304 | 1.186-1.435 | <0.001 | 1.283 | 1.166-1.412 | <0.001 |
| Gender | Female / Male | 0.999 | 0.928-1.075 | 0.984 | NI | 0.994 | 0.914-1.082 | 0.895 | NI | ||||
| Race | Black / White / Others | 0.949 | 0.876-1.027 | 0.194 | NI | 0.937 | 0.855-1.026 | 0.159 | |||||
| Tumor size (cm) | ≤ 2 / 2∼4 / >4 | 1.137 | 1.066-1.213 | <0.001 | 1.148 | 1.075-1.225 | <0.001 | 1.135 | 1.054-1.222 | 0.001 | 1.138 | 1.056-1.226 | 0.001 |
| Tumor grade | Well / Moderate / Poor | 1.115 | 1.048-1.186 | 0.001 | 1.077 | 1.012-1.147 | 0.019 | 1.119 | 1.043-1.200 | 0.002 | 1.081 | 1.007-1.160 | 0.032 |
| LN metastasis | Absent / Present | 1.076 | 0.996-1.162 | 0.064 | NI | 1.072 | 0.981-1.172 | 0.123 | NI | ||||
| Tumor site | Head / Body / Tail | 0.956 | 0.909-1.006 | 0.082 | NI | 0.960 | 0.960-1.016 | 0.157 | NI | ||||
| Radiotherapy | No / Yes | 0.640 | 0.592-0.691 | <0.001 | 0.610 | 0.565-0.660 | <0.001 | 0.630 | 0.572-0.694 | <0.001 | 0.608 | 0.552-0.671 | <0.001 |
| Chemotherapy | Without IRE / With IRE | 0.428 | 0.351-0.522 | <0.001 | 0.369 | 0.302-0.451 | <0.001 | 0.403 | 0.329-0.492 | <0.001 | 0.370 | 0.302-0.453 | <0.001 |
| SYSUCC dataset | |||||||||||||
| Age (years) | ≤ 60 / > 60 | 1.154 | 0.600-2.222 | 0.668 | NI | 0.889 | 0.351-0.253 | 0.804 | NI | ||||
| Gender | Female / Male | 2.399 | 1.077-5.343 | 0.052 | NI | 4.630 | 1.317-16.275 | 0.017 | 4.975 | 1.081-22.891 | 0.039 | ||
| Tumor size (cm) | ≤ 2 / 2∼4 / >4 | 1.657 | 0.843-3.257 | 0.143 | NI | 2.863 | 1.021-8.033 | 0.046 | 2.012 | 0.764-5.294 | 0.157 | ||
| Tumor grade | Well / Moderate / Poor | 1.182 | 0.669-2.086 | 0.565 | NI | 1.797 | 0.680-3.293 | 0.316 | NI | ||||
| LN metastasis | Absent / Present | 7.966 | 3.285-19.315 | <0.001 | 4.091 | 1.484-11.278 | 0.006 | 7.264 | 2.220-23.775 | 0.001 | 4.799 | 1.173-19.625 | 0.029 |
| Tumor site | Head / Body / Tail | 1.317 | 0.879-1.973 | 0.182 | NI | 1.310 | 0.700-2.452 | 0.398 | NI | ||||
| WBC (*109) | ≤ 10 / > 10 | 1.058 | 0.371-3.019 | 0.916 | NI | 0.463 | 0.061-3.527 | 0.457 | NI | ||||
| HGB (g/L) | ≤ 120 / > 120 | 0.852 | 0.419-1.733 | 0.659 | NI | 1.401 | 0.461-4.264 | 0.552 | NI | ||||
| PLT (*109) | ≤ 300 / > 300 | 0.513 | 0.181-1.455 | 0.209 | NI | 0.484 | 0.110-2.126 | 0.337 | NI | ||||
| ALT (U/L) | ≤ 40 / > 40 | 0.929 | 0.435-1.981 | 0.848 | NI | 1.034 | 0.365-2.929 | 0.950 | NI | ||||
| AST (U/L) | ≤ 40 / > 40 | 1.006 | 0.417-2.428 | 0.989 | NI | 0.623 | 0.143-2.719 | 0.529 | NI | ||||
| ALP (U/L) | ≤ 100 / > 100 | 1.686 | 0.867-3.277 | 0.124 | NI | 1.395 | 0.549-3.546 | 0.484 | NI | ||||
| GGT (U/L) | ≤ 45 / > 45 | 1.646 | 0.840-3.224 | 0.146 | NI | 2.106 | 0.821-5.400 | 0.121 | NI | ||||
| ALB (g/L) | ≤ 40 / > 40 | 0.261 | 0.133-0.515 | 0.101 | NI | 0.437 | 0.153-1.244 | 0.121 | NI | ||||
| TBIL (umol/L) | ≤ 20.5 / > 20.5 | 0.712 | 0.296-1.715 | 0.449 | NI | 0.360 | 0.083-1.569 | 0.174 | NI | ||||
| IBIL (umol/L) | ≤ 15 / > 15 | 0.354 | 0.048-2.589 | 0.306 | NI | 0.043 | 0.001-77.525 | 0.411 | NI | ||||
| CRP (ng/L) | ≤ 3 / > 3 | 3.312 | 1.582-6.936 | 0.001 | 1.741 | 0.757-4.005 | 0.192 | 3.094 | 1.136-8.428 | 0.127 | NI | ||
| CEA (ng/mL) | ≤ 5 / > 5 | 1.029 | 0.527-2.011 | 0.933 | NI | 1.264 | 0.495-3.232 | 0.624 | NI | ||||
| CA19-9 (U/ml) | ≤ 35 / > 35 | 1.745 | 0.676-4.507 | 0.250 | NI | 1.714 | 0.494-5.951 | 0.396 | NI | ||||
| HBsAg | Negative/Positive | 0.220 | 0.030-1.610 | 0.136 | NI | 0.264 | 0.094-0.738 | 0.011 | NI | ||||
| Chemotherapy | Without IRE/ With IRE | 0.206 | 0.082-0.515 | 0.001 | 0.363 | 0.132-0.998 | 0.050 | 0.264 | 0.094-0.738 | 0.011 | 0.313 | 0.098-0.992 | 0.048 |
| Cheotherapy type | FOLFIRINOX/Gem | 0.910 | 0.648-1.277 | 0.584 | NI | 0.852 | 0.513-1.414 | 0.535 | NI |
Conclusions
IRE combined with chemotherapy is superior to chemotherapy alone in terms of OS, CSS and PFS for patients with LAPC. This combination method may be a more suitable way of treatment for patients with LAPC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
The National Natural Science Funds (No. 81672390) and the National Key Research and Development Plan (No.2017YFC0910002).
Disclosure
All authors have declared no conflicts of interest.
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