A retrospective comparative study on the treatment of non-metastatic pancreatic cancer using high-intensity focused ultrasound versus radical surgery.

Objective: To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) and radical surgery for non-metastatic pancreatic cancer (PC).
Materials and Methods: We retrospectively analyzed 89 stage I/II/III PC patients who underwent HIFU ( n  = 43) or surgery ( n  = 46) at the Third Xiangya Hospital from January 2020 to December 2021. Pain relief, Karnofsky Performance Scale (KPS), overall survival (OS), treatment-related complications and risk factors for OS were assessed.
Results: There was no significant difference in the pain relief rate at 30 days post-treatment between the two groups. However, compared with the surgery group, the HIFU group showed significantly lower post-treatment VAS scores ( p  = 0.019). In the surgery group, the KPS at 30 days post-treatment was lower than pretreatment KPS (70 vs 80; p  = 0.015). This relationship was reversed in the HIFU group (80 vs 70; p  = 0.024). Median OS favored surgery over HIFU (23 vs 10 months; p  < 0.001), with a higher 1-year OS rate (69.57% vs 32.6%; p  < 0.001). However, there was no significant difference in OS between the two groups for stage III patients ( p  = 0.177). Complications rated ≥ grade III were 2.33% in the HIFU group and 32.6% in the surgery group. Multivariate analyses showed that age, KPS, and treatment methods were independent prognostic factors for OS.
Conclusion: HIFU demonstrates advantages over surgery in terms of early KPS, VAS improvements, and safety for pancreatic cancer; however, long-term outcomes favor surgery. For III-stage disease, HIFU was noninferior to surgery in overall survival.