Coppola Alessandro, Farolfi Tommaso, La Vaccara Vincenzo, Iannone Immacolata, Giovinazzo Francesco, Panettieri Elena, Tarallo Mariarita, Cammarata Roberto, Coppola Roberto, Caputo Damiano
Department of Surgey, Sapienza University of Rome, Viale Regina Elena 291, 00161 Rome, Italy.
General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
J Clin Med. 2023 May 25;12(11):3677. doi: 10.3390/jcm12113677.
Pancreatic ductal adenocarcinoma (PDAC) represents a challenging disease for the surgeon, oncologist, and radiation oncologist in both diagnostic and therapeutic settings. Surgery is currently the gold standard treatment, but the role of neoadjuvant treatment (NAD) is constantly evolving and gaining importance in resectable PDACs. The aim of this narrative review is to report the state of the art and future perspectives of neoadjuvant therapy in patients with PDAC.
A PubMed database search of articles published up to September 2022 was carried out.
Many studies showed that FOLFIRINOX or Gemcitabine-nab-paclitaxel in a neoadjuvant setting had a relevant impact on overall survival (OS) for patients with locally advanced and borderline resectable PDAC without increasing post-operative complications. To date, there have not been many published multicentre randomised trials comparing upfront surgery with NAD in resectable PDAC patients, but the results obtained are promising. NAD in resectable PDAC showed long-term effective benefits in terms of median OS (5-year OS rate 20.5% in NAD group vs. 6.5% in upfront surgery). NAD could play a role in the treatment of micro-metastatic disease and lymph nodal involvement. In this scenario, given the low sensitivity and specificity for lymph-node metastases of radiological investigations, CA 19-9 could be an additional tool in the decision-making process.
The future challenge could be to identify only selected patients who will really benefit from upfront surgery despite a combination of NAD and surgery.
胰腺导管腺癌（PDAC）对外科医生、肿瘤学家和放射肿瘤学家而言，在诊断和治疗方面都是一项具有挑战性的疾病。手术目前是金标准治疗方法，但新辅助治疗（NAD）的作用在可切除的PDAC中不断演变且愈发重要。本叙述性综述的目的是报告PDAC患者新辅助治疗的现状和未来前景。
对截至2022年9月发表的文章进行PubMed数据库检索。
许多研究表明，新辅助治疗中使用FOLFIRINOX或吉西他滨-纳米白蛋白紫杉醇对局部晚期和边界可切除的PDAC患者的总生存期（OS）有显著影响，且不增加术后并发症。迄今为止，在可切除的PDAC患者中，比较直接手术与NAD的多中心随机试验发表得不多，但所获得的结果很有前景。可切除的PDAC中的NAD在中位OS方面显示出长期有效的益处（NAD组5年OS率为20.5%，直接手术组为6.5%）。NAD可在微转移疾病和淋巴结受累的治疗中发挥作用。在这种情况下，鉴于放射学检查对淋巴结转移的敏感性和特异性较低，CA 19-9可能是决策过程中的一个额外工具。
未来的挑战可能是仅识别出尽管联合了NAD和手术但真正能从直接手术中获益的特定患者。
