Nießen Anna, Büchler Markus W, Hackert Thilo
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Chirurgische Universitätsklinik, Heidelberg, Deutschland.
Zentralbl Chir. 2022 Apr;147(2):168-172. doi: 10.1055/a-1775-8924. Epub 2022 Apr 4.
Pancreatic cancer could be the second leading cause of cancer death in 2030. Even though 5-year survival rates remain poor, substantial progress has been made in recent decades. The use of adjuvant chemotherapy after resection has prolonged survival and neoadjuvant concepts have been introduced to allow proportionately more resections in initially borderline resectable or locally advanced disease. Currently, there is an ongoing debate about the use of neoadjuvant therapy in both resectable and borderline resectable disease, whereas in locally advanced cancer, the use of neoadjuvant therapies is unquestionable. High-level evidence in this area remains scarce, despite numerous studies that have recently been published or are currently recruiting. A key problem is the definition of resectability which was - traditionally - based on anatomical criteria; however, it has become clear that this definition is not adequate as tumour biology as well as patient-related prognostic factors are not taken into consideration. A second unsolved problem is the difficulty to standardise neoadjuvant therapy as - in contrast to the adjuvant setting, where large randomised controlled trials have set clear standards - multiple protocols are used around the world. This does not allow us to give any clear recommendation on which therapy protocol should be chosen for a specific patient if neoadjuvant therapy is considered. Furthermore, success control under neoadjuvant treatment is not effectively defined - usually only CA 19-9 as the most common marker can aid in clinical decision making, as imaging often fails to show actual response. With regard to present guidelines, patients with resectable disease should not be treated with neoadjuvant therapy outside clinical studies, whereas for borderline resectable disease, recommendations vary between different countries and societies.This review summarises the present literature on the topic of neoadjuvant therapy in pancreatic cancer with a focus on resectable disease stage.
胰腺癌可能在2030年成为癌症死亡的第二大主要原因。尽管5年生存率仍然很低，但近几十年来已取得了重大进展。切除术后辅助化疗的应用延长了生存期，新辅助治疗的概念也已引入，以便在最初为边界可切除或局部晚期疾病的患者中进行更多比例的切除。目前，关于新辅助治疗在可切除和边界可切除疾病中的应用存在持续的争论，而在局部晚期癌症中，新辅助治疗的应用是毋庸置疑的。尽管最近发表了大量研究或正在招募研究对象，但该领域的高级别证据仍然稀缺。一个关键问题是可切除性的定义，传统上它基于解剖学标准；然而，很明显，这种定义并不充分，因为没有考虑肿瘤生物学以及与患者相关的预后因素。第二个未解决的问题是难以标准化新辅助治疗，与辅助治疗不同，辅助治疗中有大型随机对照试验设定了明确的标准，而世界各地使用了多种方案。如果考虑新辅助治疗，这使得我们无法就应为特定患者选择哪种治疗方案给出任何明确的建议。此外，新辅助治疗下的疗效控制没有得到有效定义，通常只有作为最常见标志物的CA 19-9有助于临床决策，因为影像学检查往往无法显示实际反应。关于目前的指南，可切除疾病的患者在临床研究之外不应接受新辅助治疗，而对于边界可切除疾病，不同国家和学会的建议各不相同。本综述总结了目前关于胰腺癌新辅助治疗主题的文献，重点关注可切除疾病阶段。
