General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottorassa 1035, 00168, Rome, Italy.
Hepatopancreaticobiliary Group, Saint Vincent's University Hospital, Dublin, Ireland.
J Gastrointest Surg. 2020 Oct;24(10):2336-2348. doi: 10.1007/s11605-020-04697-1. Epub 2020 Jun 24.
In literature, percentages of pathologic complete response (pCR) in patients presenting with resectable (RES), borderline resectable (BLR) or locally advanced (LA) pancreatic cancer (PaC) after neoadjuvant treatment (NADT) are variable, ranging 0-33%. Those data come mostly from retrospective reviews of single centres. The objective of this systematic review is to assess the incidence of pCR.
Following the criteria of the PRISMA statement, a literature search was conducted looking for prospective papers focusing on neoadjuvant treatment in PaC. Retrospective papers, other than ductal carcinoma histologies and trials including metastatic patients, were excluded from the present review. Data extraction was carried out by 3 independent investigators. Meta-analysis was performed with ProMeta3 Software (Internovi, 2015). PROSPERO registry: CRD42018095641.
The literature search of Embase, Cochrane and Medline with the terms "neoadjuvant OR preoperative", "pancreatic OR pancreas" and "cancer OR adenocarcinoma OR tumor" led to the identification of 3128 papers. We restricted the search to humans, last 10 years and English language articles resulting in 1158 eligible articles to review. Extended paper revision led to the inclusion of 27 papers. Complete pathologic response ranged 0-11.11%, at the meta-analysis 4% (95% CI 3-5%), in prospective studies 0-9.09% and in prospective databases 1.63-11.11%.
Pathologic complete response in pancreatic cancer is actually infrequent: high-quality studies provide a more reliable picture of neoadjuvant effects, high rates of pCR are reported in selected retrospective studies but it is overestimated.
文献中，接受新辅助治疗（NADT）后可切除（RES）、边界可切除（BLR）或局部进展（LA）胰腺癌（PaC）患者的病理完全缓解（pCR）百分比因研究而异，范围为 0-33%。这些数据主要来自单一中心的回顾性研究。本系统评价的目的是评估 pCR 的发生率。
根据 PRISMA 声明的标准，对聚焦于 PaC 新辅助治疗的前瞻性文献进行了检索。本综述排除了回顾性研究、非导管癌组织学和包括转移性患者的试验。数据提取由 3 名独立研究者进行。使用 ProMeta3 软件（Internovi，2015 年）进行荟萃分析。PROSPERO 注册：CRD42018095641。
在 Embase、Cochrane 和 Medline 上使用“新辅助或术前”、“胰腺或胰腺”和“癌症或腺癌或肿瘤”等术语进行文献检索，共检索到 3128 篇文献。我们将检索范围限制为人类、过去 10 年和英语语言文章，最终有 1158 篇文章符合审查条件。扩展的论文修订导致纳入了 27 篇论文。完全病理缓解率为 0-11.11%，荟萃分析为 4%（95%CI 3-5%），前瞻性研究为 0-9.09%，前瞻性数据库为 1.63-11.11%。
胰腺癌的病理完全缓解实际上并不常见：高质量的研究提供了更可靠的新辅助治疗效果图片，在选定的回顾性研究中报告了较高的 pCR 率，但存在高估。
