Therapeutic effect analysis of nano-knife ablation combined with gemcitabine in the treatment of locally advanced pancreatic cancer

Abstract

Objecive To investigate the safety and clinical efficacy of nano-knife ablation combined with gemcitabine in the treatment of locally advanced pancreatic cancer (LAPC). Methods From January 2014 to September 2017, the clinical data of 64 patients with LAPC admitted to the Department of Hepatobiliary Surgery, Rocket Army Characteristic Medical Center of PLA were retrospectively analyzed. Among them, 24 patients in the nano-knife ablation combined with gemcitabine treatment (combined group) and 40 patients in the single drug gemcitabine chemotherapy (control group). Serum amylase, creatine kinase and lactate dehydrogenase levels were monitored before and 1, 3, 5, 7, 14 and 30 days after treatment in the two groups. To observe the change trend of CA19-9, a tumor marker, before and 7, 14, 30, 60 and 90 days after treatment. Relevant complications in the two groups were recorded. The volume changes of tumors before and 90 days after treatment were compared between CT images and solid tumors evaluation criteria. After treatment, follow-up visits and telephone calls were conducted for 16 months. The short-term survival of the two groups was analyzed by Kaplan-Meier curve. Data were analyzed with repeated measurements of variance analysis, t test and chi-square test. Results Before treatment, serum amylase in the combined group [(41.25±20.77) U/L] was compared with the control group [(48.82±18.25) U/L], the difference was not statistically significant (t=-1.525, P=0.132). One day after treatment, the serum amylase in the combined group [(402.71±254.74) U/L] showed a transient increase, and then gradually decreased. There were no statistically significant differences between 14 days after treatment [(40.03±18.96) U/L] and 30 days after treatment [(35.76±16.02) U/L] compared with that before treatment (t=0.213, 1.025; P=0.833, 0.311). There was no significant difference in serum amylase levels of the control group at each monitoring time point (F=5.793, P=0.058). There was no significant difference in creatine kinase level between the two groups at each monitoring time point (F=2.330, 1.718; P=0.065, 0.117), and no significant difference in lactate dehydrogenase level between the two groups (F=1.240, 1.804; P=0.302, 0.137). Seven days after treatment, the level of CA19-9 in the combined group showed a transient increast, and then showd a downward trend, and there was significant difference within 90 days after treatment [(114.43±40.61) U/mL]compared with before treatment [(190.81±100.46) U/mL](t=3.453, P=0.002). The level of CA19-9 in the control group continued to rise 14 days after treatment. The difference was statistically significant within 90 days after treatment [(494.57±94.08) U/mL] compared with before treatment [(212.22±81.34) U/mL](t=-14.358, P<0.05). All patients (100.0%) during the ablation surgery in the combined group had muscle tremor in the operation area, 2 patients (8.3%) had transient blood pressure rise, 3 patients (12.5%) had mild signs of pancreatitis after operation, and no severe complications such as hemorrhage, perforation and pancreatic fistula occurred. In the control group, 12 patients (30.0%) had gastrointestinal adverse reactions, and 9 patients (22.5%) had bone marrow suppression symptoms. The tumor volume of the combined group [(14.17±12.65) cm3] was smaller than that of the control group [(26.93±17.42) cm3] at the time of 90 days after treatment, and the difference was statistically significant (t=-3.123, P=0.003). Twenty cases (83.3%) in the combined group were significantly better than 14 cases (35.0%) in the control group (χ2= 14.072, P<0.05). The follow-up showed that the average survival time of the combined group was (11.3±3.7) months and that of the control group was (7.6±3.4) months. The survival of the combined group was better than that of the control group, the difference was statistically significant (t=8.130, P=0.004). Conclusion Nano-knife ablation combined with gemcitabine chemotherapy can effectively control the local progress of pancreatic cancer and prolong survival time, which is worthy of clinical promotion. Key words: Pancreatic neoplasms; Drug therapy, combination; Ablation techniques; Treatment outcome; Comparative effectiveness research; Nano-knife