Lockie Elizabeth B, Sylivris Amy, Pandanaboyana Sanjay, Zalcberg John, Skandarajah Anita, Loveday Benjamin P
Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.
Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
BJS Open. 2025 Mar 4;9(2). doi: 10.1093/bjsopen/zraf007.
Surgery combined with chemotherapy provides the best chance of survival in pancreatic cancer. This study investigated whether increasing the resection rate at a population level improves overall survival and modelled the interaction between resection rate, perioperative mortality rate, and population survival.
A systematic review was conducted on studies reporting resection rate and survival outcomes in patients with pancreatic cancer at a population level. MEDLINE, Embase and Evidence-Based Medicine Reviews were searched up to February 2024. The primary outcome was overall population-level survival. A model for 1-year survival incorporating varying resection and perioperative mortality rates was developed.
The search identified 3967 studies; 19 were eligible (516 789 patients). A significant association was observed between resection rate and pancreatic cancer population survival at 1 year (r2 = 0.46, P = 0.001). A weak but significant association was noted between resection rate and (neo)adjuvant chemotherapy (r2 = 0.26, P = 0.03). One-year pancreatic cancer population survival was significantly associated with chemotherapy (r2 = 0.63; P = 0.004), but the effect was weaker than for resection rate (regression slope 0.26 versus 0.94 respectively). According to the developed model, for example, increasing the resection rate from 10 to 15% and perioperative mortality rate from 2 to 3% would lead to a 1-year survival increase from 17.6% to 22.1%.
A higher resection rate at a population level was associated with improved survival of the pancreatic cancer population. While some of this benefit was linked to increasing (neo)adjuvant chemotherapy use, the effect of resection rate was stronger. Strategies to enhance the resection rate at national and regional levels should be explored. Establishing a benchmark for resection rate could support patient-centred healthcare and promote equitable access to high-quality pancreatic cancer care.
手术联合化疗为胰腺癌患者提供了最佳的生存机会。本研究调查了在人群水平上提高切除率是否能改善总体生存率，并对切除率、围手术期死亡率和人群生存率之间的相互作用进行了建模。
对报告人群水平上胰腺癌患者切除率和生存结果的研究进行了系统评价。检索了截至2024年2月的MEDLINE、Embase和循证医学综述。主要结局是总体人群水平的生存率。建立了一个包含不同切除率和围手术期死亡率的1年生存率模型。
检索到3967项研究；19项符合条件（516789例患者）。观察到切除率与1年胰腺癌人群生存率之间存在显著关联（r2 = 0.46，P = 0.001）。切除率与（新）辅助化疗之间存在微弱但显著的关联（r2 = 0.26，P = 0.03）。1年胰腺癌人群生存率与化疗显著相关（r2 = 0.63；P = 0.004），但该效应比切除率弱（回归斜率分别为0.26和0.94）。例如，根据所建立的模型，将切除率从10%提高到15%，围手术期死亡率从2%提高到3%，将使1年生存率从17.6%提高到22.1%。
人群水平上较高的切除率与胰腺癌人群生存率的提高相关。虽然这种益处部分与增加（新）辅助化疗的使用有关，但切除率的影响更强。应探索在国家和地区层面提高切除率的策略。建立切除率基准可以支持以患者为中心的医疗保健，并促进公平获得高质量的胰腺癌护理。
