Sequential high-intensity focused ultrasound treatment combined with chemotherapy for inoperable pancreatic cancer: a retrospective analysis for prognostic factors and survival outcomes

Abstract

Objective

To evaluate the effect of HIFU (High-Intensity Focused Ultrasound) therapy on the survival and prognosis of patients with inoperable pancreatic cancer, and the clinical application of serological prognostic indicators.

Methods

We retrospectively analyzed the clinicopathological features, laboratory tests and follow-ups of 192 patients. Among the patients, 57 were treated with HIFU prior to chemotherapy (HIFU-priority), and 135 patients received chemotherapy followed by HIFU (HIFU-second). Univariate and multivariate Cox regression analysis was used to determine the prognostic value of tumor inflammation-related serological markers. A nomogram model was established based on the identified prognostic factors.

Results

Univariate analysis showed that receiving the treatment regimen in HIFU-priority was a significant protective factor for overall survival (OS, p < 0.001). Tumor stage, high C-reactive protein (CRP), high gamma-glutamyl transferase(γGT) high carbohydrate antigen 125 (CA125), high neutrophil-to-lymphocyte ratio (NLR), high lymphocyte-to-monocyte ratio (LMR) and liver metastasis were significant risk factors for poor prognosis (p < 0.05). CRP combined with normal tumor marker CA125 (CRP + CA125) was associated with longer OS (p = 0.005). Multivariate analysis shows that HIFU-priority is a protective factor for OS (Hazard Ratio, HR: 0.38; 95% confidence interval(CI): 0.25-0.57), tumor stage (HR: 1.61; 95% CI: 1.12-2.31), CRP + CA125 (HR: 1.46; 95% CI: 1.02-2.08) and γGT (HR: 1.44; 95% CI: 1.04-1.98) are risk factors for OS and serve as independent prognostic factors in the nomogram.

Conclusion

Early application of HIFU treatment improves the OS of patients with inoperable pancreatic cancer. CRP + CA125 and γGT are independent prognostic factors.

Keywords:

• Pancreatic cancer
• HIFU
• prognosis
• tumor markers

Author contribution

S.D: conceptualization, methodology, software, data curation, visualization, investigation, and writing – original draft preparation; A.Z.: data curation, methodology, software, and writing – original draft preparation; H.Z.: software, data curation, visualization, and investigation; K.W.: software, data curation, and visualization; C.C. and Z.M.: conceptualization, methodology, supervision, and writing – reviewing and editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data and material will be made available on request.

Additional information

Funding

This study was supported by the Shanghai Technology Development Funds (21ZR1414100), the National Natural Science Foundation of China (82204850), and the China Postdoctoral Science Foundation (2022M722142).