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<i>Meta</i>分析

doi:10.3760/cma.j.cn113030-20200914-00465

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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.

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	Wang Sheng
	Zhao Xue
	Zhang Yiqing
	Sun Kaiguo
	Qin Zhaohui
	Yao Yuanhu

Key words： Pancreatic neoplasm/neoadjuvant chemoradiotherapy Overall survival Safety Meta-analysis

Received: 14 September 2020

Fund:High-level Medical Talents “Six One Project” of Jiangsu Province (LGY2016041)

Corresponding Authors: Yao Yuanhu, Email:yyhxz@xzhmu.edu.cn

Cite this article:

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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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20200914-00465 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2021/V30/I6/575

[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(1):7-30.DOI:10.3322/caac.21590.
[2] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424.DOI:10.3322/caac.21492.
[3] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. DOI:10.3322/caac.21338.
[4] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5):e555-e567.DOI:10.1016/S2214-109X (18)30127-X.
[5] Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4):a multicentre, open-label, randomised, phase 3 trial[J]. Lancet, 2017, 389(10073):1011-1024.DOI:10.1016/S0140-6736(16)32409-6.
[6] 杨尹默. 困惑中思考挑战中前行:胰腺癌综合治疗的热点问题[J]. 中华消化外科杂志, 2019, 18(1):35-38. DOI:10.3760/cma.j.issn.1673-9752.2019.01.008.
Yang YM. Thinking in the confusion, advancing in the challenges:hotspots in the comprehensive treatment of pancreatic carcinoma[J]. Chin J Digest Surg, 2019, 18(1):35-38. DOI:10.3760/cma.j.issn.1673-9752.2019.01.008.
[7] Abrams RA, Lowy AM, O'Reilly EM, et al. Combined modality treatment of resectable and borderline resectable pancreas cancer:expert consensus statement[J]. Ann Surg Oncol, 2009, 16(7):1751-1756.DOI:10.1245/s10434-009-0413-9.
[8] Shaib WL, Ip A, Cardona K, et al. Contemporary management of borderline resectable and locally advanced unresectable pancreatic cancer[J]. Oncologist, 2016, 21(2):178-187.DOI:10.1634/theoncologist.2015-0316.
[9] Ielpo B, Caruso R, Duran H, et al. A comparative study of neoadjuvant treatment with gemcitabine plus nab-paclitaxel versus surgery first for pancreatic adenocarcinoma[J]. Surg Oncol, 2017, 26(4):402-410.DOI:10.1016/j.suronc.2017.08.003.
[10] FujⅡ T, Satoi S, Yamada S, et al. Clinical benefits of neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreatic head:an observational study using inverse probability of treatment weighting[J]. J Gastroenterol, 2017, 52(1):81-93.DOI:10.1007/s00535-016-1217-x.
[11] Golcher H, Brunner TB, Witzigmann H, et al. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer:results of the first prospective randomized phase Ⅱ trial[J]. Strahlenther Onkol, 2015, 191(1):7-16.DOI:10.1007/s00066-014-0737-7.
[12] Casadei R, Di Marco M, Ricci C, et al. Neoadjuvant chemoradiotherapy and surgery versus surgery alone in resectable pancreatic cancer:a single-center prospective, randomized, controlled trial which failed to achieve accrual targets[J]. J Gastrointest Surg, 2015, 19(10):1802-1812. DOI:10.1007/s11605-015-2890-4.
[13] Jang JY, Han Y, Lee H, et al. Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer:a prospective, randomized, open-label, multicenter phase 2/3 trial[J]. Ann Surg, 2018, 268(2):215-222. DOI:10.1097/SLA.0000000000002705.
[14] Versteijne E, Suker M, Groothuis K, et al. Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer:Results of the Dutch Randomized Phase Ⅲ PREOPANC Trial[J]. J Clin Oncol, 2020, 38(16):1763-1773.DOI:10.1200/JCO.19.02274.
[15] Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions:explanation and elaboration[J]. BMJ, 2009, 339:b2700.DOI:10.1136/bmj.b2700.
[16] Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J]. BMJ, 2011, 343: d5928. DOI:10.1136/bmj.d5928.
[17] 郝纯毅,刘续宝,孙备,等. 可能切除胰腺癌治疗的现状与争议[J]. 中华消化外科杂志, 2018, 17(7):677-681.DOI:10.3760/cma.j.issn.1673-9752.2018.07.008.
Hao CY, Liu XB, Sun B, et al. Current status and controversies in the management of borderline resectable pancreatic cancer[J]. Chin J Digest Surg, 2018, 17(7):677-681.DOI:10.3760/cma.j.issn.1673-9752.2018.07.008.
[18] 杨尹默,田孝东. 胰腺癌多学科综合治疗协作组诊疗模式专家共识[J]. 中国实用外科杂志, 2017, 37(1):35-36.DOI:10.19538/j.cjps.issn1005-2208.2017.01.11.
Yang YM, Tian XD. Expert consensus on the diagnosis and treatment model of the collaborative group of multidisciplinary comprehensive treatment for pancreatic cancer[J]. Chin J Pract Surg, 2017, 37(1):35-36.DOI:10.19538/j.cjps.issn1005-2208.2017.01.11.
[19] 王春友,金钢,戴梦华,等. 胰腺癌新辅助治疗的选择策略[J]. 中华消化外科杂志, 2019, 18(7):648-656.DOI:10.3760/cma.j.issn.1673-9752.2019.07.008.
Wang CY, Jin G, Dai MH, et al. Selection strategy of neoadjuvant therapy for pancreatic cancer[J]. Chin J Digest Surg, 2019, 18(7):648-656.DOI:10.3760/cma.j.issn.1673-9752.2019.07.008.
[20] Shi S, Hua J, Yu X. Neoadjuvant treatment for pancreatic cancer:still a controversial issue?[J]. J Clin Oncol, 2020, 38(25):2943-2944.DOI:10.1200/JCO.20.00631.
[21] Ratnayake B, Savastyuk AY, Nayar M, et al. Recurrence patterns for pancreatic ductal adenocarcinoma after upfront resection versus resection following neoadjuvant therapy:a comprehensive meta-analysis[J]. J Clin Med, 2020, 9(7):2132. DOI:10.3390/jcm9072132.
[22] Sho M, Akahori T, Tanaka T, et al. Optimal indication of neoadjuvant chemoradiotherapy for pancreatic cancer[J]. Langenbecks Arch Surg, 2015, 400(4):477-485. DOI:10.1007/s00423-015-1304-0.
[23] Sho M, Akahori T, Tanaka T, et al. Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine andconcurrent radiation for resectable pancreatic cancer[J]. J Hepatobiliary Pancreat Sci, 2013, 20(2):197-205. DOI:10.1007/s00534-012-0532-8.
[24] Tomihara H, Eguchi H, Yamada D, et al. Preoperative chemoradiotherapy does not compromise the feasibility of adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma[J]. Surg Today, 2017, 47(2):218-226.DOI:10.1007/s00595-016-1405-6.
[25] Tachezy M, Gebauer F, Petersen C, et al. Sequential neoadjuvant chemoradiotherapy (CRT) followed by curative surgery vs. primary surgery alone for resectable, non-metastasized pancreatic adenocarcinoma:NEOPA-a randomized multicenter phase Ⅲ study (NCT01900327, DRKS00003893, ISRCTN82191749)[J]. BMC Cancer, 2014, 14:411.DOI:10.1186/1471-2407-14-411.