General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy.
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Pancreatology. 2024 Nov;24(7):1107-1114. doi: 10.1016/j.pan.2024.09.010. Epub 2024 Sep 13.
The impact of chemoradiotherapy on pathologic response, resection margin, and survival benefit is still debated. The aim of this study was to compare the rate of pathologic complete response (pCR) in surgical resection following neoadjuvant chemotherapy vs. chemoradiotherapy, and secondarily, to compare the rate of R0 resection and Overall Survival (OS).
A systematic review on MEDLINE/PubMed, Embase, Cochrane, Web of Science and Google Scholar was conducted for studies published between 2012 and 2024 (PROSPERO CRD42022341467). All studies reporting clinical outcomes of patients with Pancreatic ductal adenocarcinoma (PDAC) following neoadjuvant therapy were considered eligible for inclusion. A meta-analysis comparing the rate of pCR, R0 resection rate, and 3-year OS following Chemotherapy vs chemoradiotherapy in patients was performed. The overall quality of evidence was evaluated using a GRADE approach.
Out of 5194 potentially relevant studies, 29 studies were considered eligible for full-text assessment, and 11 studies were included in the systematic review and in the meta-analysis. Of these, five were retrospective single-center, five retrospective multi-center studies, and one was a phase II multi-center RCT. Overall, 1830 Chemotherapy patients and 2299 Chemoradiotherapy patients were included in the meta-analysis. A statistically significant increased rate of pCR and R0 resections were found in chemoradiotherapy patients (OR 3.58, 95 % CI 2.47-5.18, p ≤ 0.00001) (OR 1.49, 95 % CI 1.17-1.90, p = 0.001), whereas 3-year OS (OR 1.07, 95 % CI 0.84-1.36, p = 0.6) did not differ significantly.
Chemoradiotherapy may have a positive impact on pathologic response and R0 resection rate, whereas a survival benefit was not reported.
新辅助化疗对病理反应、切缘和生存获益的影响仍存在争议。本研究旨在比较新辅助化疗后手术切除的病理完全缓解（pCR）率，并次要比较 R0 切除率和总生存期（OS）。
对 2012 年至 2024 年期间发表的 MEDLINE/PubMed、Embase、Cochrane、Web of Science 和 Google Scholar 上的研究进行了系统评价（PROSPERO CRD42022341467）。所有报告新辅助治疗后胰腺导管腺癌（PDAC）患者临床结局的研究均符合纳入标准。对化疗与放化疗后患者的 pCR 率、R0 切除率和 3 年 OS 进行了比较 meta 分析。使用 GRADE 方法评估总体证据质量。
在 5194 篇潜在相关研究中，有 29 篇研究被认为符合全文评估标准，11 篇研究被纳入系统评价和 meta 分析。其中，5 项为回顾性单中心研究，5 项为回顾性多中心研究，1 项为多中心 II 期 RCT。总体上，有 1830 名化疗患者和 2299 名放化疗患者纳入了 meta 分析。放化疗患者的 pCR 率和 R0 切除率显著升高（OR 3.58，95%CI 2.47-5.18，p≤0.00001）（OR 1.49，95%CI 1.17-1.90，p=0.001），而 3 年 OS（OR 1.07，95%CI 0.84-1.36，p=0.6）无显著差异。
放化疗可能对病理反应和 R0 切除率有积极影响，但未报告生存获益。
