Tarek Kellil, Amine Tormane Mohamed, Rami Rhaiem, Amal Amara, Francesca Gianpaoli, Stephane Sanchez, Tullio Piardi
Department of Surgery HBP Unit, Simone Veil Hospital, University of Reims Champagne-Ardenne, Troyes, France.
Hepatobiliary and Pancreatic Surgery Department, Robert Debré Hospital, University of Reims Champagne-Ardenne, Reims, France.
Langenbecks Arch Surg. 2025 Sep 10;410(1):269. doi: 10.1007/s00423-025-03778-6.
Pancreatic adenocarcinomas (PDAC) have a poor prognosis, with a 5-year relative Survival rate of 11.5%. Only 20% of patients are initially eligible for resection, and 50% of patients presented with metastatic disease, currently only candidates' palliative treatment. This meta-analysis compares the outcomes of surgical treatment versus chemotherapy or palliative care for M-PDAC.
A literature search was performed on May, 9th of 2024. A meta-analysis was then conducted. The primary outcome was Overall Survival and the secondary outcomes were 1-year Survival and 3-year survival. Subgroup analysis was also performed, based on metastatic sites.
The analyses showed a significant benefit of surgical treatment in terms of overall survival (HR: 0.42, 95% CI [0.33- 0.53]), 1-year survival (OR: 0.37, CI 95% [0.26, 0.52]), and 3-year survival (OR: 0.16, CI 95% [0.07, 0.383]). In the subgroup analysis based on metastatic site, the benefit of surgical treatment persisted for liver-only metastases (HR : 0.40, CI 95% [0.29, 0.53]), but not for lung-only metastases.
This meta-analysis showed a survival advantage for surgical treatment in patients with M-PDAC and especially in liver-only metastases. Prospective trials are needed to confirm these findings and refine patient selection criteria for surgical treatment.
胰腺腺癌（PDAC）预后较差，5年相对生存率为11.5%。只有20%的患者最初适合手术切除，50%的患者出现转移性疾病，目前仅适合姑息治疗。本荟萃分析比较了M-PDAC手术治疗与化疗或姑息治疗的结果。
于2024年5月9日进行文献检索。随后进行荟萃分析。主要结局为总生存期，次要结局为1年生存期和3年生存期。还根据转移部位进行了亚组分析。
分析显示，手术治疗在总生存期（HR：0.42，95%CI[0.33 - 0.53]）、1年生存期（OR：0.37，95%CI[0.26，0.52]）和3年生存期（OR：0.16，95%CI[0.07，0.383]）方面有显著益处。在基于转移部位的亚组分析中，手术治疗的益处仅在仅肝转移患者中持续存在（HR：0.40，95%CI[0.29，0.53]），而在仅肺转移患者中不存在。
本荟萃分析显示，手术治疗对M-PDAC患者，尤其是仅肝转移患者有生存优势。需要进行前瞻性试验以证实这些发现并完善手术治疗的患者选择标准。
