新辅助治疗后切除与 upfront 切除后胰腺导管腺癌的复发模式：一项综合荟萃分析

Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis.

作者信息

Ratnayake Bathiya, Savastyuk Alina Y, Nayar Manu, Wilson Colin H, Windsor John A, Roberts Keith, French Jeremy J, Pandanaboyana Sanjay

机构信息

Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand.

Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, Tyne and Wear, UK.

出版信息

J Clin Med. 2020 Jul 6;9(7):2132. doi: 10.3390/jcm9072132.

BACKGROUND

Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review seeks to compare sites and patterns of recurrence after resection between patients undergoing upfront surgery (US) or after NAT.

METHODS

The EMBASE, SCOPUS, PubMed, and Cochrane library databases were systematically searched to identify eligible studies that compare recurrence patterns between patients who had NAT (followed by resection) with those that had US. The primary outcome included site-specific recurrence.

RESULTS

26 articles were identified including 4986 patients who underwent resection. Borderline resectable pancreatic cancer (BRPC, 47% 1074/2264) was the most common, followed by resectable pancreatic cancer (RPC 42%, 949/2264). The weighted overall recurrence rates were lower among the NAT group, 63.4% vs. 74% (US) (OR 0.67 (CI 0.52-0.87), = 0.006). The overall weighted locoregional recurrence rate was lower amongst patients who received NAT when compared to US (12% vs 27% OR 0.39 (CI 0.22-0.70), = 0.004). In BRPC, locoregional recurrence rates improved with NAT (NAT 25.8% US 37.7% OR 0.62 (CI 0.44-0.87), = 0.007). NAT was associated with a lower weighted liver recurrence rate (NAT 19.4% US 30.1% OR 0.55 (CI 0.34-0.89), = 0.023). Lung and peritoneal recurrence rates did not differ between NAT and US cohorts ( = 0.705 and = 0.549 respectively). NAT was associated with a significantly longer weighted mean time to first recurrence 18.8 months compared to US (15.7 months) (OR 0.18 (CI 0.05-0.32), = 0.015).

CONCLUSION

NAT was associated with lower overall recurrence rate and improved locoregional disease control particularly for those with BRPC. Although the burden of liver metastases was less, there was no overall effect upon distant metastatic disease.

背景

新辅助治疗（NAT）代表了胰腺导管腺癌（PDAC）患者管理模式的转变，其潜在益处包括更高的R0切除率。然而，目前尚不清楚NAT是否会影响术后复发的部位和模式。本综述旨在比较接受直接手术（US）或NAT后患者切除术后复发的部位和模式。

方法

系统检索EMBASE、SCOPUS、PubMed和Cochrane图书馆数据库，以确定比较接受NAT（随后进行切除）的患者与接受US的患者复发模式的符合条件的研究。主要结局包括特定部位的复发。

结果

共纳入26篇文章，包括4986例接受切除术的患者。边缘可切除胰腺癌（BRPC，47%，1074/2264）最为常见，其次是可切除胰腺癌（RPC，42%，949/2264）。NAT组的加权总复发率较低，为63.4%，而US组为74%（OR 0.67（CI 0.52 - 0.87），P = 0.006）。与US组相比，接受NAT的患者总体加权局部区域复发率较低（12%对27%，OR 0.39（CI 0.22 - 0.70），P = 0.004）。在BRPC中，NAT使局部区域复发率有所改善（NAT为25.8%，US为37.7%，OR 0.62（CI 0.44 - 0.87），P = 0.007）。NAT与较低的加权肝复发率相关（NAT为19.4%，US为30.1%，OR 0.55（CI 0.34 - 0.89），P = 0.023）。NAT组和US组的肺和腹膜复发率无差异（分别为P = 0.705和P = 0.549）。与US组（15.7个月）相比，NAT与显著更长的加权首次复发平均时间相关（18.8个月）（OR 0.18（CI 0.05 - 0.32），P = 0.015）。