Background/Objectives: Neoadjuvant therapy (NAT) improves surgical outcomes in pancreatic cancer, but its role in elderly patients remains unclear. Due to comorbidities and lower chemotherapy tolerance, assessing NAT’s benefits and risks in this population is essential. This systematic review assesses the impact of NAT on overall survival (OS), surgical resection rates, and treatment-related toxicities(G3-4) in elderly patients with resectable, borderline, or locally advanced pancreatic cancer.Methods: A systematic search was conducted in PubMed, MEDLINE, EMBASE, Scopus, and Cochrane databases according to PRISMA guidelines. Studies reporting that NAT outcomes in elderly patients (≥70 years) were included. The Newcastle–Ottawa scale was used to assess study quality. Subgroup analyses compared NAT versus upfront surgery and outcomes in elderly versus younger patients.Results: Twelve studies (four prospective and eight retrospective) including 11,385 patients met the inclusion criteria. Among 9580 elderly patients, only 24% underwent NAT. NAT significantly improved R0 resection rates compared to upfront surgery (p< 0.001), and elderly patients receiving NAT had a median OS of 26.5 (range 15.7–39.1) months versus 20.3 months (range 11.5–23.8) of upfront surgery and versus 36.2 months (range 23.6–43.0) of NAT in young patients. Elderly patients experienced higher rates of major toxicities (17–57.5%). Personalized regimens, such as gemcitabine/nab-paclitaxel, were better tolerated than FOLFIRINOX.Conclusions: NAT is associated with improved survival and surgical outcomes in elderly pancreatic cancer patients, despite a higher risk of adverse events. Patient selection based on performance status rather than age alone is essential to optimize treatment benefits. Further prospective trials are needed to refine treatment approaches in this population.
背景/目的：新辅助治疗（NAT）可改善胰腺癌患者的手术结局，但其在老年患者中的作用尚不明确。由于合并症较多且化疗耐受性较低，评估NAT在该人群中的获益与风险至关重要。本系统综述旨在评估NAT对可切除、交界可切除或局部晚期胰腺癌老年患者总生存期（OS）、手术切除率及治疗相关毒性（3-4级）的影响。 方法：根据PRISMA指南，在PubMed、MEDLINE、EMBASE、Scopus和Cochrane数据库中进行系统检索。纳入报告老年患者（≥70岁）NAT结局的研究。采用纽卡斯尔-渥太华量表评估研究质量。通过亚组分析比较NAT与直接手术的差异，以及老年患者与年轻患者的结局。 结果：共12项研究（4项前瞻性、8项回顾性）符合纳入标准，涉及11,385例患者。在9,580例老年患者中，仅24%接受了NAT。与直接手术相比，NAT显著提高了R0切除率（p<0.001）；接受NAT的老年患者中位OS为26.5个月（范围15.7–39.1），而直接手术组为20.3个月（范围11.5–23.8），年轻患者接受NAT的中位OS为36.2个月（范围23.6–43.0）。老年患者发生严重毒性的比例更高（17–57.5%）。吉西他滨/白蛋白紫杉醇等个体化方案的耐受性优于FOLFIRINOX方案。 结论：尽管不良事件风险较高，NAT仍与老年胰腺癌患者生存及手术结局的改善相关。基于体能状态而非仅凭年龄进行患者选择，对优化治疗获益至关重要。需要进一步开展前瞻性试验以完善该人群的治疗策略。
肿瘤(癌症)患者之家