Background: Despite advances in treatment, the prognosis of resectable pancreatic adenocarcinoma remains poor. Neoadjuvant therapy (NAT) has gained great interest in hopes of improving survival. However, the results of available studies based on different treatment approaches, such as chemotherapy and chemoradiotherapy, showed contrasting results. The aim of this systematic review and meta-analysis is to clarify the benefit of NAT compared to upfront surgery (US) in primarily resectable pancreatic adenocarcinoma. Methods: A PRISMA literature review identified 139 studies, of which 15 were finally included in the systematic review and meta-analysis. All data from eligible articles was summarized in a systematic summary and then used for the meta-analysis. Specifically, we used HR for OS and DFS and risk estimates (odds ratios) for the R0 resection rate and the N+ rate. The risk of bias was correctly assessed according to the nature of the studies included. Results: From the pooled HRs, OS for NAT patients was better, with an HR for death of 0.80 (95% CI: 0.72–0.90) at a significance level of less than 1%. In the sub-group analysis, no difference was found between patients treated with chemoradiotherapy or chemotherapy exclusively. The meta-analysis of seven studies that reported DFS for NAT resulted in a pooled HR for progression of 0.66 (95% CI: 0.56–0.79) with a significance level of less than 1%. A significantly lower risk of positive lymph nodes (OR: 0.45; 95% CI: 0.32–0.63) and an improved R0 resection rate (OR: 1.70; 95% CI: 1.23–2.36) were also found in patients treated with NAT, despite high heterogeneity. Conclusions: NAT is associated with improved survival for patients with resectable pancreatic adenocarcinoma; however, the optimal treatment strategy has yet to be defined, and further studies are required.
背景：尽管治疗手段有所进步，可切除胰腺腺癌的预后仍然较差。新辅助治疗（NAT）因有望改善生存期而备受关注。然而，基于不同治疗方法（如化疗和放化疗）的现有研究结果显示出相互矛盾的结论。本系统综述和荟萃分析旨在阐明NAT与直接手术（US）相比在初始可切除胰腺腺癌中的获益。 方法：通过PRISMA文献检索共识别139项研究，其中15项最终纳入系统综述和荟萃分析。所有符合条件文章的数据均经过系统性汇总，随后用于荟萃分析。具体而言，我们采用风险比（HR）评估总生存期（OS）和无病生存期（DFS），采用风险估计值（比值比）评估R0切除率和淋巴结阳性率。根据纳入研究的性质对偏倚风险进行了规范评估。 结果：从合并HR值来看，接受NAT的患者OS更优，死亡HR为0.80（95% CI：0.72–0.90），显著性水平小于1%。亚组分析显示，单纯接受放化疗或化疗的患者之间未见差异。对7项报告NAT患者DFS的研究进行荟萃分析，得出疾病进展的合并HR为0.66（95% CI：0.56–0.79），显著性水平小于1%。尽管存在高度异质性，接受NAT治疗的患者淋巴结阳性风险显著降低（OR：0.45；95% CI：0.32–0.63），R0切除率也得到改善（OR：1.70；95% CI：1.23–2.36）。 结论：NAT与可切除胰腺腺癌患者生存期的改善相关；然而，最佳治疗策略尚未明确，仍需进一步研究。
肿瘤(癌症)患者之家