Clinical effect of gemcitabine combined with high-intensity focused ultrasound in treatment of advanced pancreatic cancer: A Meta-analysis

Objective To evaluate the clinical effect and safety of high-intensity focused ultrasound(HIFU) combined with gemcitabine in the treatment of advanced pancreatic cancer. Methods SCI,Cochrane Library,Embase,PubMed,Wanfang Data,CNKI,CBM,and VIP were searched for randomized controlled trials(RCTs) of HIFU combined with gemcitabine in the treatment of advanced pancreatic cancer,with the assistance of expanded search,and these RCTs were screened according to the inclusion criteria. Review Manager 5. 3 was used to perform the Meta-analysis. A fixed effects model was used for non-heterogeneous data; heterogeneity was explained by subgroup analysis based on intervention methods,and if it could not be explained by subgroup analysis,a random effects model was used. Relative risk(RR) and 95% confidence interval(CI) were used as evaluation indices,and funnel plots were generated based on the outcome measure involved in the highest number of studies. Results A total of 8 RCTs with 474 patients were included. The patients in the experimental group received gemcitabine-based chemotherapy and HIFU,and those in the control group received gemcitabine-based chemotherapy alone. Compared with the control group,the experimental group had significantly better results in 3-,6-,and 12-month survival rates(3-month: RR = 1. 07,95% CI: 1. 00-1. 14,P < 0. 05; 6-month: RR = 2. 19,95% CI: 1. 75-2. 75,P < 0. 05; 12-month: RR =2. 35,95% CI: 1. 07-5. 14,P < 0. 05),tumor control(RR = 1. 64,95% CI: 1. 21-2. 24,P = 0. 002),and pain control(RR = 3. 15,95% CI: 2. 45-4. 05,P < 0. 05). There were no significant differences between the two groups in the incidence rates of leukopenia(RR =1. 05,95% CI: 0. 85-1. 30,P > 0. 05),gastrointestinal reactions(RR = 0. 89,95% CI: 0. 56-1. 42,P > 0. 05),and liver injury(RR = 1. 29,95% CI: 0. 95-1. 75,P > 0. 05). Since the outcome measure of pain control was involved in the highest number of studies,funnel plots were generated and showed no significant risk of bias. Conclusion Compared with gemcitabine alone,HIFU combined with gemcitabine can increase patients' survival rate and improve their symptoms,with a similar incidence rate of adverse effects. Further studies are needed for this combined therapy.