Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
Chin Clin Oncol. 2022 Jun;11(3):19. doi: 10.21037/cco-21-87. Epub 2022 Jun 2.
Patients with pancreatic cancer frequently develop postoperative disease recurrence, even after surgical resection with curative intent. Because of the heterogeneity of this patient population, phase III trials have never been conducted to establish a standard therapy for patients with post-surgical recurrence, and no uniform consensus based on high-level evidence exists as to which intervention might be the most appropriate. The aim of this review is to introduce globally popular treatment strategies for pancreatic cancer patients with postoperative recurrences.
This is a narrative review, summarising the contemporary evidence and emerging studies with treatment for postoperative recurrence of pancreatic cancer.
For patients with local recurrence alone, various therapeutic strategies have been attempted, including repeat surgical resection, chemoradiotherapy, and chemotherapy alone. Several studies have examined the outcomes of these therapies, but most are retrospective analyses of a small number of patients and statistically too underpowered to allow any solid recommendations to be made. Therefore, with the exception that there appears to be a potential benefit of repeat resection for isolated recurrences in the pancreatic remnant in a selected subgroup of patients, the patient outcomes remain dismal. In regard to the management of patients with distant recurrences, postoperative distant recurrences are generally not considered as being distinct from primary metastatic disease, and most patients with distant recurrence(s) with/without local tumor recurrence receive systemic chemotherapy as the standard therapy for metastatic disease; some studies have demonstrated a trend toward better survival outcomes in patients with a history of surgical resection than in those without a history of surgical resection.
Although no uniform consensus based on high-level evidence exists, systemic chemotherapy has been used as the main treatment option, and some regimens have been demonstrated to offer a survival benefit. There is an urgent need for prospective trials to establish the most appropriate treatment strategies for this patients' population.
胰腺癌患者即使接受根治性手术切除后，也常发生术后疾病复发。由于该患者群体的异质性，从未开展过 III 期临床试验来为术后复发患者确立标准治疗方法，也没有基于高级别证据的统一共识来确定哪种干预措施最合适。本综述旨在介绍全球流行的用于治疗胰腺癌术后复发患者的治疗策略。
这是一篇叙述性综述，总结了治疗胰腺癌术后复发的当代证据和新兴研究。
对于仅局部复发的患者，已经尝试了各种治疗策略，包括再次手术切除、放化疗和单纯化疗。有几项研究探讨了这些治疗方法的结果，但大多数都是对少数患者进行的回顾性分析，而且在统计学上没有足够的效力来做出任何可靠的推荐。因此，除了在少数患者中，孤立性胰腺残部复发似乎有再次手术切除的潜在获益外，患者的结局仍然很差。对于远处复发患者的管理，术后远处复发通常不被视为与原发性转移疾病不同，大多数远处复发（伴/不伴局部肿瘤复发）患者都接受全身化疗作为转移性疾病的标准治疗；一些研究表明，有手术切除史的患者比没有手术切除史的患者的生存结局更好。
尽管没有基于高级别证据的统一共识，但全身化疗已被用作主要治疗选择，一些方案已显示出生存获益。迫切需要前瞻性试验来为这一患者群体确立最合适的治疗策略。
