The primary treatment for operable pancreatic cancer (PC) involves surgery followed by adjuvant therapy. Nevertheless, perioperative or neoadjuvant chemotherapy (CT) may be used to mitigate the likelihood of recurrence and mortality. This network meta-analysis (NMA) assesses the comparative efficacy of various treatment approaches for resectable PC. A thorough search was carried out on January 31, 2023, encompassing PubMed/MEDLINE, Cochrane Library, and Embase databases. We incorporated randomized clinical trials (RCTs) that compared surgical interventions with or without (neo)adjuvant or perioperative therapies for operable PC. We conducted a fixed-effects Bayesian NMA. We presented the effect sizes in terms of hazard ratios (HRs) for overall survival (OS) along with 95% credible intervals (95% CrIs). The treatment was deemed statistically superior when the 95% credible interval (CrI) did not encompass a null value (hazard ratio < 1). Treatment rankings were established based on the surface under the cumulative ranking curve (SUCRA). A total of 24 studies were incorporated, comparing 21 treatments with surgery in isolation. Eleven treatments showed superior efficacy compared to surgery alone, with HRs ranging from 0.38 for perioperative treatments to 0.73 for adjuvant 5-fluorouracil. After the exclusion of studies conducted in Asia, it was found that the perioperative regimen of gemcitabine combined with nab-paclitaxel was the most effective regimen (SUCRA,p= 0.99). The findings endorse the utilization of perioperative CT, especially multi-agent CT, as the favored intervention for operable PC in Western nations.
可手术胰腺癌的主要治疗方式为手术联合辅助治疗。然而，围手术期或新辅助化疗可用于降低复发和死亡风险。本网状荟萃分析评估了可切除胰腺癌不同治疗方案的相对疗效。我们于2023年1月31日系统检索了PubMed/MEDLINE、Cochrane Library和Embase数据库，纳入比较可手术胰腺癌单纯手术与联合（新）辅助或围手术期治疗的随机临床试验。采用固定效应贝叶斯网状荟萃分析法，以总生存期的风险比及其95%可信区间呈现效应值。当95%可信区间不包含无效值（风险比<1）时，认为该治疗方案具有统计学优势。根据累积排序曲线下面积确定治疗方案排序等级。共纳入24项研究，比较了21种治疗方案与单纯手术的疗效。其中11种方案疗效优于单纯手术，风险比范围从围手术期治疗的0.38至辅助5-氟尿嘧啶的0.73。排除亚洲地区研究后，发现吉西他滨联合白蛋白结合型紫杉醇的围手术期方案是最有效的治疗方案（SUCRA,p=0.99）。研究结果支持在西方国家将围手术期化疗，特别是多药联合化疗，作为可手术胰腺癌的首选治疗方案。
肿瘤(癌症)患者之家