Zhang Hao-Qi, Li Jing, Tan Chun-Lu, Chen Yong-Hua, Zheng Zhen-Jiang, Liu Xu-Bao
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Operating Room/West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastrointest Oncol. 2022 Oct 15;14(10):1903-1917. doi: 10.4251/wjgo.v14.i10.1903.
Currently, 15 randomized controlled trials (RCTs) have been designed to investigate whether neoadjuvant therapy (NAT) benefits patients with resectable pancreatic adenocarcinoma (R-PA) compared to surgery alone. Five of them have acquired results so far; however, corresponding conclusions have not been obtained. We speculated that the reason for this phenomenon could be that some prognostic factors had proven to be adverse through upfront surgery curative patterns, but some of them were not regarded as independent baseline characteristics, which is important to obtaining comparability between the NAT and upfront surgery groups. This fact could cause bias and lead to the difference in the outcomes of RCTs. In this review, we collate data about risk factors (such as tumor size, resection margin, and lymph node status) influencing the prognoses of patients with R-PA from five RCTs and discuss the possible reasons for the varying outcomes.
目前，已有15项随机对照试验（RCT）旨在研究新辅助治疗（NAT）与单纯手术相比，是否对可切除胰腺癌（R-PA）患者有益。其中5项试验目前已取得结果；然而，尚未得出相应结论。我们推测，出现这种现象的原因可能是一些预后因素已通过 upfront 手术治愈模式被证明是不利的，但其中一些因素并未被视为独立的基线特征，而这对于在NAT组和 upfront 手术组之间获得可比性很重要。这一事实可能会导致偏差，并导致RCT结果出现差异。在本综述中，我们整理了来自5项RCT的关于影响R-PA患者预后的危险因素（如肿瘤大小、切缘和淋巴结状态）的数据，并讨论了结果各异的可能原因。
