Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Br J Surg. 2021 Mar 12;108(2):119-127. doi: 10.1093/bjs/znaa031.
Preoperative chemo(radio)therapy is used increasingly in pancreatic cancer. Histological evaluation of the tumour response provides information on the efficacy of preoperative treatment and is used to determine prognosis and guide decisions on adjuvant treatment. This systematic review aimed to provide an overview of the current evidence on tumour response scoring systems in pancreatic cancer.
Studies reporting on the assessment of resected pancreatic ductal adenocarcinoma following neoadjuvant chemo(radio)therapy were searched using PubMed and EMBASE. All original studies reporting on histological tumour response in relation to clinical outcome (survival, recurrence-free survival) or interobserver agreement were eligible for inclusion. This systematic review followed the PRISMA guidelines.
The literature search yielded 1453 studies of which 25 met the eligibility criteria, revealing 13 unique scoring systems. The most frequently investigated tumour response scoring systems were the College of American Pathologists system, Evans scoring system, and MD Anderson Cancer Center system, investigated 11, 9 and 5 times respectively. Although six studies reported a survival difference between the different grades of these three systems, the reported outcomes were often inconsistent. In addition, 12 of the 25 studies did not report on crucial aspects of pathological examination, such as the method of dissection, sampling approach, and amount of sampling.
Numerous scoring systems for the evaluation of tumour response after preoperative chemo(radio)therapy in pancreatic cancer exist, but comparative studies are lacking. More comparative data are needed on the interobserver variability and prognostic significance of the various scoring systems before best practice can be established.
术前化疗（放疗）在胰腺癌中的应用日益增多。肿瘤反应的组织学评估提供了术前治疗效果的信息，并用于确定预后和指导辅助治疗决策。本系统评价旨在概述目前关于胰腺癌肿瘤反应评分系统的证据。
使用 PubMed 和 EMBASE 搜索报告新辅助化疗（放疗）后切除的胰腺导管腺癌评估的研究。所有报告与临床结果（生存、无复发生存）或观察者间一致性相关的组织学肿瘤反应的原始研究均符合纳入标准。本系统评价遵循 PRISMA 指南。
文献检索产生了 1453 项研究，其中 25 项符合纳入标准，揭示了 13 种独特的评分系统。研究最多的肿瘤反应评分系统是美国病理学家学院系统、Evans 评分系统和 MD 安德森癌症中心系统，分别研究了 11、9 和 5 次。尽管有 6 项研究报告了这三种系统的不同等级之间的生存差异，但报告的结果往往不一致。此外，25 项研究中有 12 项没有报告病理检查的关键方面，如解剖方法、取样方法和取样量。
存在许多用于评估胰腺癌术前化疗（放疗）后肿瘤反应的评分系统，但缺乏比较性研究。在建立最佳实践之前，需要更多关于各种评分系统的观察者间变异性和预后意义的比较数据。
