Impact of neoadjuvant chemoradiotherapy on pathologic response in pancreatic ductal adenocarcinoma: A systematic review and meta-analysis

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2024-11-01 DOI:10.1016/j.pan.2024.09.010

Quoc Riccardo Bao , Marco Ventin , Lorenzo Dell’Atti , Marzia Tripepi , Isabella Frigerio , Giovanni Butturini , Filippo Crimì , Marco Scarpa , Salvatore Pucciarelli , Cristina R. Ferrone , Gaya Spolverato

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引用次数: 0

Abstract

Background

The impact of chemoradiotherapy on pathologic response, resection margin, and survival benefit is still debated. The aim of this study was to compare the rate of pathologic complete response (pCR) in surgical resection following neoadjuvant chemotherapy vs. chemoradiotherapy, and secondarily, to compare the rate of R0 resection and Overall Survival (OS).

Methods

A systematic review on MEDLINE/PubMed, Embase, Cochrane, Web of Science and Google Scholar was conducted for studies published between 2012 and 2024 (PROSPERO CRD42022341467). All studies reporting clinical outcomes of patients with Pancreatic ductal adenocarcinoma (PDAC) following neoadjuvant therapy were considered eligible for inclusion. A meta-analysis comparing the rate of pCR, R0 resection rate, and 3-year OS following Chemotherapy vs chemoradiotherapy in patients was performed. The overall quality of evidence was evaluated using a GRADE approach.

Results

Out of 5194 potentially relevant studies, 29 studies were considered eligible for full-text assessment, and 11 studies were included in the systematic review and in the meta-analysis. Of these, five were retrospective single-center, five retrospective multi-center studies, and one was a phase II multi-center RCT. Overall, 1830 Chemotherapy patients and 2299 Chemoradiotherapy patients were included in the meta-analysis. A statistically significant increased rate of pCR and R0 resections were found in chemoradiotherapy patients (OR 3.58, 95 % CI 2.47–5.18, p ≤ 0.00001) (OR 1.49, 95 % CI 1.17–1.90, p = 0.001), whereas 3-year OS (OR 1.07, 95 % CI 0.84–1.36, p = 0.6) did not differ significantly.

Conclusions

Chemoradiotherapy may have a positive impact on pathologic response and R0 resection rate, whereas a survival benefit was not reported.

查看原文本刊更多论文

新辅助化放疗对胰腺导管腺癌病理反应的影响：系统综述和荟萃分析。

背景：化放疗对病理反应、切除边缘和生存获益的影响仍存在争议。本研究旨在比较新辅助化疗与化疗放疗后手术切除的病理完全反应率（pCR），其次比较R0切除率和总生存率（OS）：方法：在 MEDLINE/PubMed、Embase、Cochrane、Web of Science 和 Google Scholar 上对 2012 年至 2024 年间发表的研究进行了系统回顾（PROSPERO CRD42022341467）。所有报告胰腺导管腺癌（PDAC）患者接受新辅助治疗后临床疗效的研究均符合纳入条件。荟萃分析比较了化疗与化疗放疗后患者的 pCR 率、R0 切除率和 3 年 OS。采用 GRADE 方法对证据的总体质量进行了评估：在 5194 项可能相关的研究中，29 项研究被认为符合全文评估条件，11 项研究被纳入系统综述和荟萃分析。其中，5 项为回顾性单中心研究，5 项为回顾性多中心研究，1 项为 II 期多中心 RCT 研究。荟萃分析共纳入了1830名化疗患者和2299名化放疗患者。化放疗患者的 pCR 和 R0 切除率明显增加（OR 3.58，95 % CI 2.47-5.18，p ≤ 0.00001）（OR 1.49，95 % CI 1.17-1.90，p = 0.001），而 3 年 OS（OR 1.07，95 % CI 0.84-1.36，p = 0.6）没有明显差异：结论：化放疗可能对病理反应和R0切除率有积极影响，但未报告化放疗对生存有益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.