Takaori Kyoichi, Bassi Claudio, Biankin Andrew, Brunner Thomas B, Cataldo Ivana, Campbell Fiona, Cunningham David, Falconi Massimo, Frampton Adam E, Furuse Junji, Giovannini Marc, Jackson Richard, Nakamura Akira, Nealon William, Neoptolemos John P, Real Francisco X, Scarpa Aldo, Sclafani Francesco, Windsor John A, Yamaguchi Koji, Wolfgang Christopher, Johnson Colin D
Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy.
Pancreatology. 2016 Jan-Feb;16(1):14-27. doi: 10.1016/j.pan.2015.10.013. Epub 2015 Nov 12.
Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies.
A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent.
Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines.
The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.
胰腺癌是最具毁灭性的疾病之一，死亡率极高。医学组织和科学协会已发布多项指南以指导胰腺癌的积极治疗。本共识性综述的目的是确定现有指南之间的共识与分歧所在，并帮助明确未来研究的空白。
一组胰腺病学专家齐聚第46届欧洲胰腺俱乐部会议暨第18届国际胰腺病学协会会议，共同对八篇关于胰腺癌临床管理的英文指南进行批判性审查。九个领域的专家分别提出了感兴趣的临床问题（CQs）。对现有指南中CQs的建议及其依据的证据进行了审查和比较。证据被评为充分、中等或不足/缺乏。
36个CQs中只有4个有充分证据达成共识。另外5个CQs尽管缺乏充分证据但也达成了共识。在22个CQs中，无论有无证据都存在分歧。现有指南未充分涉及5个CQs。
现有指南提供了基于证据和共识的建议。部分建议也存在相当大的分歧，部分原因是缺乏高水平证据。改善胰腺癌患者的临床管理需要持续努力开展研究，以提供足够证据达成共识。
