文章：

胰腺癌新辅助治疗与直接手术——适用人群、时机及方法探讨？

Neoadjuvant Therapy or Upfront Surgery for Pancreatic Cancer—To Whom, When, and How?

原文发布日期：6 August 2025

DOI: 10.3390/cancers17152584

类型: Article

开放获取: 是

英文摘要：

The management of resectable pancreatic ductal adenocarcinoma (R-PDAC) and borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) remains a topic of active debate. Although neoadjuvant therapy (NAT) has shown clinical benefits in BR-PDAC, especially in increasing resectability and achieving higher rates of margin-negative (R0) resections, its role in R-PDAC is less clearly defined. Additionally, the role of immunotherapy in PDAC is still being explored, with ongoing trials investigating new combinations to overcome the tumor’s immune-resistant microenvironment. This article provides a comprehensive narrative review of the current evidence comparing NAT with upfront surgery in pancreatic cancer management, focusing on randomized controlled trials and meta-analyses that assess outcomes in R-PDAC and BR-PDAC. The review aims to determine whether NAT offers a significant survival advantage over traditional post-operative strategies and to clarify which clinical scenarios may benefit most from NAT. The literature was identified through a systematic search of PubMed, Scopus, and Google Scholar databases up to March 2025. Article selection adhered to the PRISMA guidelines. Our review of existing evidence supports NAT as the standard of care for BR-PDAC. Meanwhile, management of R-PDAC should be tailored individually, guided by risk stratification that considers both clinical parameters and molecular features. Immunotherapy and targeted therapies are still in early research phases, and their further integration as NAT remains controversial.

摘要翻译： 

可切除胰腺导管腺癌（R-PDAC）与交界可切除胰腺导管腺癌（BR-PDAC）的治疗策略仍是当前学术讨论的焦点。新辅助治疗（NAT）在BR-PDAC中已显示出明确的临床获益，尤其在提高切除率与阴性切缘（R0）达成率方面，但其在R-PDAC中的作用尚未完全明确。同时，免疫治疗在PDAC领域的应用仍处于探索阶段，多项临床试验正致力于通过新型联合方案克服肿瘤的免疫抑制微环境。本文通过系统梳理现有证据，聚焦于比较胰腺癌治疗中NAT与直接手术疗效的随机对照试验及荟萃分析，重点评估R-PDAC与BR-PDAC的临床结局。本综述旨在明确NAT是否较传统术后辅助策略具有显著生存优势，并厘清何种临床情境最能从NAT中获益。文献检索基于截至2025年3月的PubMed、Scopus及Google Scholar数据库系统检索，文章筛选严格遵循PRISMA指南。现有证据支持将NAT作为BR-PDAC的标准治疗方案；而对R-PDAC的治疗决策需结合临床参数与分子特征进行风险分层，实施个体化策略。免疫治疗与靶向治疗仍处于早期研究阶段，其作为新辅助治疗组成部分的临床应用价值尚存争议。

原文链接：

Neoadjuvant Therapy or Upfront Surgery for Pancreatic Cancer—To Whom, When, and How?