In addition to established evidence of the efficacy of adjuvant chemotherapy (AC) for pancreatic ductal adenocarcinoma (PDAC), evidence of the effects of neoadjuvant treatments (NATs), including chemotherapy and chemoradiotherapy, has also been accumulating. Recent results from prospective studies and meta-analyses suggest that NATs may be beneficial not only for borderline resectable PDAC, but also for resectable PDAC, by increasing the likelihood of successful R0 resection, decreasing the likelihood of the development of lymph node metastasis, and improving recurrence-free and overall survival. In addition, response to NAT may be informative for predicting the clinical course after preoperative NAT followed by surgery; in this way, the postoperative treatment strategy can be revised based on the effect of NAT and the post-neoadjuvant therapy/surgery histopathological findings. On the other hand, the response to NAT and AC is also influenced by the tumor biology and the patient’s immune/nutritional status; therefore, planning of the treatment strategy and meticulous management of NAT, surgery, and AC is required on a patient-by-patient basis. Our experience of using gemcitabine plus S-1 showed that this NAT regimen achieved tumor shrinkage and decreased the levels of tumor markers but failed to provide a survival benefit. Our results also suggested that response/adverse events to NAT may be predictive of the efficacy of AC, as well as survival outcomes.
除辅助化疗（AC）对胰腺导管腺癌（PDAC）疗效的既定证据外，新辅助治疗（NAT，包括化疗和放化疗）效果的相关证据也在不断积累。近期前瞻性研究和荟萃分析结果表明，NAT不仅可能对临界可切除PDAC有益，对可切除PDAC同样具有积极意义——通过提高R0切除成功率、降低淋巴结转移发生率，并改善无复发生存期和总生存期。此外，对NAT的治疗反应可为预测术前NAT联合手术后的临床病程提供参考；基于NAT疗效及新辅助治疗后手术的病理学结果，可相应调整术后治疗策略。另一方面，NAT和AC的疗效也受肿瘤生物学特性及患者免疫/营养状态的影响，因此需要根据个体情况制定治疗策略，并对NAT、手术及AC进行精细化管理。我们使用吉西他滨联合S-1的经验表明，该NAT方案虽能实现肿瘤缩小并降低肿瘤标志物水平，但未能带来生存获益。我们的研究结果还提示，对NAT的治疗反应/不良事件可能预测AC疗效及生存结局。
肿瘤(癌症)患者之家