Tanadi Caroline, Tandarto Kevin, Stella Maureen Miracle, Adiwinata Randy, Tenggara Jeffry Beta, Simadibrata Paulus, Simadibrata Marcellus
School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia (Caroline Tanadi, Kevin Tandarto, Maureen Miracle Stella).
Gastrointestinal Cancer Center, MRCCC Siloam Hospital Semanggi (Randy Adiwinata, Paulus Simadibrata).
Ann Gastroenterol. 2025 Jul-Aug;38(4):453-461. doi: 10.20524/aog.2025.0972. Epub 2025 Jun 25.
Pancreatic cancer is among the leading causes of cancer-related deaths worldwide. Resectable pancreatic cancer is typically treated with curative resection, often followed by adjuvant therapy. Despite this, recurrence rates remain high after resection. Additionally, micro-metastases may develop during the immediate postoperative period. To address this issue, neoadjuvant therapy has been proposed. This review aimed to assess the effectiveness of neoadjuvant treatment compared to surgery as first approach in resectable pancreatic cancer.
A comprehensive literature search was conducted up to October 2, 2024, in CENTRAL, PubMed, ProQuest, SAGE and JSTOR. Randomized controlled trials (RCTs) evaluating the effects of neoadjuvant treatment in patients with resectable pancreatic cancer were included.
A total of 5422 articles were identified after duplicate removal. Following the screening process, 8 RCTs were included. No significant difference was observed in the overall survival (OS) among those who received neoadjuvant therapy and those who underwent upfront surgery (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.72-1.18; P=0.51). Additionally, the groups' disease-free survival (DFS) was comparable (HR 0.98, 95%CI 0.80-1.20; P=0.83). Patients who received neoadjuvant treatment had noticeably higher R0 resection rates compared to the upfront surgery group (risk ratio 1.31, 95%CI 1.11-1.55; P=0.002).
When compared to upfront surgery, neoadjuvant therapy significantly improved the R0 resection rates, but had no significant effect on OS or DFS. More research is required to confirm the potential benefits of neoadjuvant therapy in treating resectable pancreatic cancer.
胰腺癌是全球癌症相关死亡的主要原因之一。可切除的胰腺癌通常采用根治性切除术治疗，术后常需辅助治疗。尽管如此，切除术后的复发率仍然很高。此外，微转移可能在术后即刻发生。为解决这一问题，人们提出了新辅助治疗。本综述旨在评估新辅助治疗与手术作为可切除胰腺癌的首选治疗方法相比的有效性。
截至2024年10月2日，在CENTRAL、PubMed、ProQuest、SAGE和JSTOR数据库中进行了全面的文献检索。纳入评估新辅助治疗对可切除胰腺癌患者疗效的随机对照试验（RCT）。
去除重复文献后共识别出5422篇文章。经过筛选过程，纳入了8项RCT。接受新辅助治疗的患者与接受直接手术的患者相比，总生存期（OS）无显著差异（风险比[HR]0.92，95%置信区间[CI]0.72 - 1.18；P = 0.51）。此外，两组的无病生存期（DFS）相当（HR 0.98，95%CI 0.80 - 1.20；P = 0.83）。与直接手术组相比，接受新辅助治疗的患者R0切除率明显更高（风险比1.31，95%CI 1.11 - 1.55；P = 0.002）。
与直接手术相比，新辅助治疗显著提高了R0切除率，但对OS或DFS无显著影响。需要更多研究来证实新辅助治疗在治疗可切除胰腺癌方面的潜在益处。
