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可切除或交界可切除胰腺癌新辅助放化疗+手术对比直接手术疗效及安全性Meta分析
王胜1, 赵雪1, 张一擎1, 孙开国1, 覃朝晖2, 姚元虎1
1徐州医科大学附属医院肿瘤放疗科 221002; 2徐州医科大学管理学院 221004
Comparison of efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer:a Meta-analysis
Wang Sheng1, Zhao Xue1, Zhang Yiqing1, Sun Kaiguo1, Qin Zhaohui2, Yao Yuanhu1
1Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; 2School of Public Health, Xuzhou Medical University, Xuzhou 221004, China
Abstract：Objective To systematically evaluate the efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer. Methods Literature review was performed from PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang, CNKI and VIP from the inception date to February, 2020 using the key words including “pancreatic neoplasm, pancreatic cancer, surgery, preoperative chemoradiotherapy, neoadjuvant chemoradiotherapy”in both English and Chinese. The randomized controlled clinical trials (RCTs) of neoadjuvant chemoradiotherapy followed by surgery versus immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer were searches. Literature screening, data extraction and estimation of the risk of bias were independently conducted by two researchers. The HR and 95%CI were used for estimating the overall survival time. The R0 resection rate, overall incidence of postoperative complications, and mortality rate throughout treatment were assessed by the RR and 95%CI. The heterogeneity of the studies was analyzed using the I2 test. Results A total of 4 RCTs were included. Among 400 patients, 197 cases were assigned into the neoadjuvant chemoradiotherapy combined with surgery group and 203 in the immediate surgery group. The results of Meta-analysis showed that patients in the neoadjuvant chemoradiotherapy followed by surgery group obtained longer overall survival (HR=0.76, 95%CI:0.60-0.97, P=0.03) and higher R0 resection rate (RR=1.72, 95%CI:1.40-2.13, P<0.01). Besides, the overall incidence of postoperative complications (RR=1.02, 95%CI:0.73-1.43, P=0.90) and mortality rate throughout treatment (RR=1.19, 95%CI:0.48-2.93, P=0.71) did not significantly differ between two groups. Conclusions During the treatment of resectable or borderline resectable pancreatic cancer, neoadjuvant chemoradiotherapy followed by surgery may bring more survival benefits than immediate surgery and does not increase the incidence of postoperative complications and mortality rate throughout treatment. Therefore, neoadjuvant chemoradiotherapy followed by surgery can be used as a recommended treatment for patients with resectable or borderline resectable pancreatic cancer.
Wang Sheng,Zhao Xue,Zhang Yiqing et al. Comparison of efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer:a Meta-analysis[J]. Chinese Journal of Radiation Oncology, 2021, 30(6): 575-581.
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2021, Vol. 30 
