Cloyd Jordan M, Sarna Angela, Arango Matthew J, Bates Susan E, Bhutani Manoop S, Bloomston Mark, Chung Vincent, Dotan Efrat, Ferrone Cristina R, Gambino Patricia F, Goenka Ajit H, Goodman Karyn A, Hall William A, He Jin, Hogg Melissa E, Jayaraman Shiva, Kambadakone Avinash, Katz Matthew H G, Khorana Alok A, Ko Andrew H, Koay Eugene J, Kooby David A, Krishna Somashekar G, Larsson Liliana K, Lee Richard T, Maitra Anirban, Massarweh Nader N, Mikhail Sameh, Muzaffar Mahvish, O'Reilly Eileen M, Palta Manisha, Petzel Maria Q B, Philip Philip A, Reyngold Marsha, Santa Mina Daniel, Sohal Davendra P S, Sundaresan Tilak K, Tsai Susan, Turner Kea L, Vreeland Timothy J, Walston Steve, Washington M Kay, Williams Terence M, Wo Jennifer Y, Snyder Rebecca A
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus.
The Ohio State University Wexner Medical Center, Columbus.
JAMA Surg. 2025 Feb 1;160(2):172-180. doi: 10.1001/jamasurg.2024.5191.
Neoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined.
To develop consensus best practices for delivering NT to patients with localized PDAC.
DESIGN, SETTING, AND PARTICIPANTS: This study used a modified Delphi approach consisting of 2 rounds of voting, and a series of virtual conferences (from October to December 2023) to reach expert consensus on candidate best practice statements generated from a systematic review of the literature and expert opinion. An interdisciplinary panel was formed including 47 North American experts from surgical, medical, and radiation oncology, radiology, pathology, gastroenterology, integrative oncology, anesthesia, pharmacy, nursing, cancer care delivery research, and nutrition as well as patient and caregiver stakeholders.
Statements that reached 75% agreement or greater were included in final consensus statements.
Of the 47 participating panel members, 27 (57.64%) were male, and the mean (SD) age was 47.6 (8.2) years. Physicians reported completing training a mean (SD) 14.6 (8.6) years prior and seeing a mean (SD) 110.6 (38.4) patients with PDAC annually; 35 (77.7%) were in academic practice. Final consensus was reached on 82 best practices for delivering NT. Of these, 38 statements focused on pre-NT practices, including diagnosis and staging (n = 15), evaluation and optimization (n = 20), and decision-making (n = 3); 29 statements defined best practices during NT, including initiation (n = 3), delivery of therapy (n = 8), restaging practices (n = 12), and management of complications during NT (n = 6); and 15 best practices were identified to guide treatment post-NT, focusing on surgery (n = 7), pathology (n = 4), and follow-up (n = 3).
Using a modified Delphi consensus technique, best practice guidelines were developed focusing on the optimal standards for delivering NT to patients with localized PDAC. Given the prognostic importance of completing multimodality therapy, efforts to standardize and optimize the delivery of NT represent an immediate opportunity to decrease care variation and improve outcomes for patients with PDAC. Future research should focus on validating and implementing best practice standards into clinical practice.
新辅助治疗（NT）是局部胰腺导管腺癌（PDAC）患者越来越常用的治疗策略。关于NT期间癌症护理的研究很少，并且尚未确定NT最佳实施的标准。
制定针对局部PDAC患者实施NT的共识最佳实践。
设计、设置和参与者：本研究采用改良的德尔菲法，包括两轮投票以及一系列虚拟会议（2023年10月至12月），以就通过对文献的系统评价和专家意见生成的候选最佳实践声明达成专家共识。组建了一个跨学科小组，包括47名来自北美外科、医学和放射肿瘤学、放射学、病理学、胃肠病学、综合肿瘤学、麻醉学、药学、护理、癌症护理研究和营养领域的专家，以及患者和护理人员利益相关者。
达成75%或更高共识的声明被纳入最终共识声明。
47名参与小组成员中，27名（57.64%）为男性，平均（标准差）年龄为47.6（8.2）岁。医生报告平均（标准差）在14.6（8.6）年前完成培训，每年平均（标准差）诊治110.6（38.4）例PDAC患者；35名（77.7%）在学术机构工作。就实施NT的82条最佳实践达成了最终共识。其中，38条声明侧重于NT前的实践，包括诊断和分期（n = 15）、评估和优化（n = 20）以及决策（n = 3）；29条声明定义了NT期间的最佳实践，包括开始（n = 3）、治疗实施（n = 8）、重新分期实践（n = 12）以及NT期间并发症的管理（n = 6）；确定了15条最佳实践以指导NT后的治疗，重点是手术（n = 7）、病理学（n = 4）和随访（n = 3）。
采用改良的德尔菲共识技术，制定了侧重于为局部PDAC患者实施NT的最佳标准的最佳实践指南。鉴于完成多模式治疗对预后的重要性，标准化和优化NT实施的努力是减少护理差异并改善PDAC患者结局的直接机会。未来的研究应侧重于在临床实践中验证和实施最佳实践标准。
