Orlandi Elena, Vecchia Stefano, Anselmi Elisa, Toscani Ilaria, Guasconi Massimo, Perrone Gennaro, Citterio Chiara, Banchini Filippo, Giuffrida Mario
Department of Oncology-Hematology, Azienda USL of Piacenza, 29121 Piacenza, Italy.
Department of Pharmacy, Azienda USL of Piacenza, 29121 Piacenza, Italy.
Cancers (Basel). 2025 Feb 22;17(5):747. doi: 10.3390/cancers17050747.
: Neoadjuvant therapy (NAT) improves surgical outcomes in pancreatic cancer, but its role in elderly patients remains unclear. Due to comorbidities and lower chemotherapy tolerance, assessing NAT's benefits and risks in this population is essential. This systematic review assesses the impact of NAT on overall survival (OS), surgical resection rates, and treatment-related toxicities(G3-4) in elderly patients with resectable, borderline, or locally advanced pancreatic cancer. : A systematic search was conducted in PubMed, MEDLINE, EMBASE, Scopus, and Cochrane databases according to PRISMA guidelines. Studies reporting that NAT outcomes in elderly patients (≥70 years) were included. The Newcastle-Ottawa scale was used to assess study quality. Subgroup analyses compared NAT versus upfront surgery and outcomes in elderly versus younger patients. : Twelve studies (four prospective and eight retrospective) including 11,385 patients met the inclusion criteria. Among 9580 elderly patients, only 24% underwent NAT. NAT significantly improved R0 resection rates compared to upfront surgery ( < 0.001), and elderly patients receiving NAT had a median OS of 26.5 (range 15.7-39.1) months versus 20.3 months (range 11.5-23.8) of upfront surgery and versus 36.2 months (range 23.6-43.0) of NAT in young patients. Elderly patients experienced higher rates of major toxicities (17-57.5%). Personalized regimens, such as gemcitabine/nab-paclitaxel, were better tolerated than FOLFIRINOX. : NAT is associated with improved survival and surgical outcomes in elderly pancreatic cancer patients, despite a higher risk of adverse events. Patient selection based on performance status rather than age alone is essential to optimize treatment benefits. Further prospective trials are needed to refine treatment approaches in this population.
新辅助治疗（NAT）可改善胰腺癌的手术效果，但其在老年患者中的作用仍不明确。由于合并症和化疗耐受性较低，评估NAT在该人群中的益处和风险至关重要。本系统评价评估了NAT对可切除、临界可切除或局部晚期老年胰腺癌患者总生存期（OS）、手术切除率及治疗相关毒性（3-4级）的影响。
根据PRISMA指南，在PubMed、MEDLINE、EMBASE、Scopus和Cochrane数据库中进行了系统检索。纳入报道老年患者（≥70岁）NAT治疗结果的研究。采用纽卡斯尔-渥太华量表评估研究质量。亚组分析比较了NAT与直接手术以及老年与年轻患者的治疗结果。
12项研究（4项前瞻性研究和8项回顾性研究）共11385例患者符合纳入标准。在9580例老年患者中，仅24%接受了NAT。与直接手术相比，NAT显著提高了R0切除率（<0.001），接受NAT的老年患者中位OS为26.5个月（范围15.7-39.1个月），直接手术组为20.3个月（范围11.5-23.8个月），年轻患者接受NAT组为36.2个月（范围23.6-43.0个月）。老年患者发生严重毒性反应的比例更高（17%-57.5%）。吉西他滨/白蛋白结合型紫杉醇等个体化方案的耐受性优于FOLFIRINOX。
NAT与老年胰腺癌患者生存率和手术效果的改善相关，尽管不良事件风险较高。基于体能状态而非单纯年龄进行患者选择对于优化治疗益处至关重要。需要进一步开展前瞻性试验以完善该人群的治疗方法。
