Schorn Stephan, Demir Ihsan Ekin, Haller Bernhard, Scheufele Florian, Reyes Carmen Mota, Tieftrunk Elke, Sargut Mine, Goess Ruediger, Friess Helmut, Ceyhan Güralp Onur
Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany.
Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
Surg Oncol. 2017 Mar;26(1):105-115. doi: 10.1016/j.suronc.2017.01.007. Epub 2017 Feb 2.
To assess the impact of neural invasion/NI on overall survival/OS and tumor recurrence in pancreatic ductal adenocarcinoma/PDAC.
NI is a histopathological hallmark of PDAC. Although some studies suggested an important role for NI on OS, disease-free/DFS and progression-free survival/PFS in PDAC, there is still no consensus on the actual role of NI on survival and local recurrence in PDAC.
Pubmed, Cochrane library, Ovid and Google Scholar were screened for the terms "pancreatic ductal adenocarcinoma", "pancreatic cancer", "survival", "tumor recurrence" and "perineural invasion". The Preferred-Reporting-Items-for-Systematic-review-and-Meta-Analysis/PRISMA-guidelines were used for systematic review and meta-analysis. Articles meeting predefined criteria were critically analysed on relevance, and meta-analyses were performed by pooling univariate and multivariate hazard ratios/HR.
A total number of 25 studies on the influence of NI on tumor recurrence, and 121 studies analysing the influence of NI on survival were identified by systematic review. The HR of the univariate (HR 1.88; 95%-CI 1.71-2.07; p < 0.00001) and multivariate meta-analysis (HR 1.68; 95%-CI 1.47-1.92; p < 0.00001) showed a major impact of NI on OS. Likewise, NI was associated with decreased DFS (HR 2.53; 95%-CI: 1.67-3.83; p = 0.0001) and PFS (HR 2.41; 95%-CI: 1.73-3.37: p < 0.00001) multivariate meta-analysis.
Although the power of this study is limited by missing pathological procedures to assess the true incidence of NI, NI appears to be an independent prognostic factor for OS, DFS and PFS in PDAC. Therefore, NI should be increasingly considered in patient stratification and in the development of novel therapeutic algorithms.
评估神经侵犯（NI）对胰腺导管腺癌（PDAC）总生存期（OS）和肿瘤复发的影响。
NI是PDAC的组织病理学特征。尽管一些研究表明NI对PDAC的OS、无病生存期（DFS）和无进展生存期（PFS）具有重要作用，但关于NI在PDAC生存和局部复发中的实际作用仍未达成共识。
在PubMed、Cochrane图书馆、Ovid和谷歌学术中检索“胰腺导管腺癌”、“胰腺癌”、“生存”、“肿瘤复发”和“神经周围侵犯”等关键词。采用系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价和Meta分析。对符合预定义标准的文章进行相关性严格分析，并通过汇总单变量和多变量风险比（HR）进行Meta分析。
通过系统评价确定了25项关于NI对肿瘤复发影响的研究，以及121项分析NI对生存影响的研究。单变量Meta分析（HR 1.88；95%置信区间1.71 - 2.07；p < 0.00001）和多变量Meta分析（HR 1.68；95%置信区间1.47 - 1.92；p < 0.00001）显示NI对OS有重大影响。同样，多变量Meta分析显示NI与DFS降低（HR 2.53；95%置信区间：1.67 - 3.83；p = 0.0001）和PFS降低（HR 2.41；95%置信区间：1.73 - 3.37：p < 0.00001）相关。
尽管本研究的效能受到缺乏评估NI真实发生率的病理程序的限制，但NI似乎是PDAC中OS、DFS和PFS的独立预后因素。因此，在患者分层和新型治疗算法的开发中应越来越多地考虑NI。
