Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients.
Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients.
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DOI：
10.1186/s12957-017-1240-2
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发表时间：
2017-10-10
影响因子：
3.2
通讯作者：
Are C
中科院分区：
文献类型：
--
作者：
Dhir M;Malhotra GK;Sohal DPS;Hein NA;Smith LM;O'Reilly EM;Bahary N;Are C
近年来，胰腺癌的解剖学定义已经标准化，新辅助治疗(NAT)的使用也越来越多。目前综述的目的是总结自2009年以来胰腺癌NAT的证据，当时公认的可切除(R)、交界性可切除(BR)和局部晚期(LA)疾病的标准被认可。进行PubMed搜索，并广泛反向搜索已发表文章的参考文献，以确定利用NAT治疗胰腺癌的研究。还检索了ASCO-GI 2014和2015年的摘要。共有96项研究，包括5520名患者，被纳入最终的定量综合。合并评估显示NAT期间36%的≥ 3级毒性、5%的胆道并发症、21%的住院率和低死亡率(0%，范围0-16%)。大多数患者(59%)病情稳定。在意向治疗的基础上，R0切除率在R患者中为63%，在LA患者中为23%。在所有NAT后切除的患者中，R0率为>； 80%。在NAT后行手术的R和BR患者中，中位OS分别为30和27.4个月。目前的研究总结了胰腺癌NAT的最新文献，并证明了与以往胰腺癌手术为主的方法相比，NAT后的结果有所改善。本文的在线版本(10.1186/s12957-017-1240-2)包含补充材料，可供授权用户使用。
Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed. PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched. A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0–16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively. The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma. The online version of this article (10.1186/s12957-017-1240-2) contains supplementary material, which is available to authorized users.
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