703P - Association of combination of irreversible electroporation ablation and chemotherapy with outcomes of locally advanced pancreatic cancer: A large cohort study

Abstract

BackgroundLocally 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. MethodsLocally 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. ResultsBefore 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: 703PUnivariate and multivariate analyses of OS in patientsTable: 703PCharacteristicBefore PSMAfter PSMUnivariate analysisMultivariate analysisUnivariate analysisMultivariate analysisHR95%CIPHR95%CIPHR95%CIPHR95% CIPSEER datasetAge (years)≤ 60 / > 601.2951.193-1.406<0.0011.2811.180-1.391<0.0011.3041.186-1.435<0.0011.2831.166-1.412<0.001GenderFemale / Male0.9990.928-1.0750.984NI0.9940.914-1.0820.895NIRaceBlack / White / Others0.9490.876-1.0270.194NI0.9370.855-1.0260.159Tumor size (cm)≤ 2 / 2∼4 / >41.1371.066-1.213<0.0011.1481.075-1.225<0.0011.1351.054-1.2220.0011.1381.056-1.2260.001Tumor gradeWell / Moderate / Poor1.1151.048-1.1860.0011.0771.012-1.1470.0191.1191.043-1.2000.0021.0811.007-1.1600.032LN metastasisAbsent / Present1.0760.996-1.1620.064NI1.0720.981-1.1720.123NITumor siteHead / Body / Tail0.9560.909-1.0060.082NI0.9600.960-1.0160.157NIRadiotherapyNo / Yes0.6400.592-0.691<0.0010.6100.565-0.660<0.0010.6300.572-0.694<0.0010.6080.552-0.671<0.001ChemotherapyWithout IRE / With IRE0.4280.351-0.522<0.0010.3690.302-0.451<0.0010.4030.329-0.492<0.0010.3700.302-0.453<0.001SYSUCC datasetAge (years)≤ 60 / > 601.1540.600-2.2220.668NI0.8890.351-0.2530.804NIGenderFemale / Male2.3991.077-5.3430.052NI4.6301.317-16.2750.0174.9751.081-22.8910.039Tumor size (cm)≤ 2 / 2∼4 / >41.6570.843-3.2570.143NI2.8631.021-8.0330.0462.0120.764-5.2940.157Tumor gradeWell / Moderate / Poor1.1820.669-2.0860.565NI1.7970.680-3.2930.316NILN metastasisAbsent / Present7.9663.285-19.315<0.0014.0911.484-11.2780.0067.2642.220-23.7750.0014.7991.173-19.6250.029Tumor siteHead / Body / Tail1.3170.879-1.9730.182NI1.3100.700-2.4520.398NIWBC (*109)≤ 10 / > 101.0580.371-3.0190.916NI0.4630.061-3.5270.457NIHGB (g/L)≤ 120 / > 1200.8520.419-1.7330.659NI1.4010.461-4.2640.552NIPLT (*109)≤ 300 / > 3000.5130.181-1.4550.209NI0.4840.110-2.1260.337NIALT (U/L)≤ 40 / > 400.9290.435-1.9810.848NI1.0340.365-2.9290.950NIAST (U/L)≤ 40 / > 401.0060.417-2.4280.989NI0.6230.143-2.7190.529NIALP (U/L)≤ 100 / > 1001.6860.867-3.2770.124NI1.3950.549-3.5460.484NIGGT (U/L)≤ 45 / > 451.6460.840-3.2240.146NI2.1060.821-5.4000.121NIALB (g/L)≤ 40 / > 400.2610.133-0.5150.101NI0.4370.153-1.2440.121NITBIL (umol/L)≤ 20.5 / > 20.50.7120.296-1.7150.449NI0.3600.083-1.5690.174NIIBIL (umol/L)≤ 15 / > 150.3540.048-2.5890.306NI0.0430.001-77.5250.411NICRP (ng/L)≤ 3 / > 33.3121.582-6.9360.0011.7410.757-4.0050.1923.0941.136-8.4280.127NICEA (ng/mL)≤ 5 / > 51.0290.527-2.0110.933NI1.2640.495-3.2320.624NICA19-9 (U/ml)≤ 35 / > 351.7450.676-4.5070.250NI1.7140.494-5.9510.396NIHBsAgNegative/Positive0.2200.030-1.6100.136NI0.2640.094-0.7380.011NIChemotherapyWithout IRE/ With IRE0.2060.082-0.5150.0010.3630.132-0.9980.0500.2640.094-0.7380.0110.3130.098-0.9920.048Cheotherapy typeFOLFIRINOX/Gem0.9100.648-1.2770.584NI0.8520.513-1.4140.535NI ConclusionsIRE 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. Legal entity responsible for the studyThe authors. FundingThe National Natural Science Funds (No. 81672390) and the National Key Research and Development Plan (No.2017YFC0910002). DisclosureAll authors have declared no conflicts of interest.