新辅助治疗对胰腺导管腺癌复发模式影响的荟萃分析。
Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma.
作者信息
Schorn S, Demir I E, Samm N, Scheufele F, Calavrezos L, Sargut M, Schirren R M, Friess H, Ceyhan G O
机构信息
Department of Surgery, Klinikum rechts der Isar, School of Medicine Technical University of Munich, Ismaningerstrasse 22 D-81675 Munich Germany.
出版信息
BJS Open. 2018 Mar 30;2(2):52-61. doi: 10.1002/bjs5.46. eCollection 2018 Apr.
BACKGROUND
Neoadjuvant therapy may increase the rate of radical tumour resection in patients with pancreatic cancer. Its impact on tumour recurrence has not been investigated fully. This study aimed to assess the impact of neoadjuvant therapy on patterns of recurrence.
METHODS
A systematic review was performed of articles identified through the PubMed, Scopus, Embase, Ovid and Google Scholar databases that analysed the relationship between neoadjuvant therapy and recurrence published to January 2016. The main endpoint was overall tumour recurrence. Other endpoints included local recurrence, any kind of distant, hepatic, pulmonary or peritoneal metastasis.
RESULTS
A total of 4257 citations were reviewed. Twelve observational studies comprising 1365 patients were analysed. Neoadjuvant therapy significantly reduced the risk of overall (risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·90; P < 0·001) and local (RR 0·42, 0·32 to 0·55; P < 0·001) recurrence. Neoadjuvant therapy did not reduce the risk of any kind of distant (RR 1·02, 0·91 to 1·14; P = 0·78), hepatic (RR 0·86, 0·68 to 1·10; P = 0·23), pulmonary (RR 0·99, 0·37 to 2·66; P = 0·98) or peritoneal (RR 0·88, 0·57 to 1·38; P = 0·58) metastasis.
CONCLUSION
Neoadjuvant therapy reduced the risk of local recurrence but not that of distant metastasis.
背景
新辅助治疗可能会提高胰腺癌患者的肿瘤根治性切除率。其对肿瘤复发的影响尚未得到充分研究。本研究旨在评估新辅助治疗对复发模式的影响。
方法
对通过PubMed、Scopus、Embase、Ovid和谷歌学术数据库检索到的截至2016年1月发表的分析新辅助治疗与复发关系的文章进行系统综述。主要终点是总体肿瘤复发。其他终点包括局部复发、任何类型的远处转移、肝转移、肺转移或腹膜转移。
结果
共检索到4257篇文献。分析了12项观察性研究，共1365例患者。新辅助治疗显著降低了总体复发风险（风险比（RR）0.82，95%置信区间0.74至0.90；P<0.001）和局部复发风险（RR 0.42，0.32至0.55；P<0.001）。新辅助治疗未降低任何类型远处转移（RR 1.02，0.91至1.14；P = 0.78）、肝转移（RR 0.86，0.68至1.10；P = 0.23）、肺转移（RR 0.99，0.37至2.66；P = 0.98）或腹膜转移（RR 0.88，0.57至1.38；P = 0.58）的风险。
结论
新辅助治疗降低了局部复发风险，但未降低远处转移风险。
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