伴有同步肝转移的IV期胰腺导管腺癌（PDAC）：肝切除术是否有生存益处？系统回顾和荟萃分析。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-01-13 DOI:10.1016/j.ejso.2025.109598

Vincenzo D'Ambra , Claudio Ricci , Carlo Ingaldi , Laura Alberici , Margherita Minghetti , Riccardo Casadei

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引用次数: 0

摘要

目的：转移性PDAC预后极差，手术治疗作用有限。该研究旨在评估PDAC合并同步肝转移患者接受手术治疗（ST）与非手术治疗（NST）的OS。方法：采用随机效应荟萃分析。纳入标准为：PDAC组织学；研究报告技术切除的肝转移病例和生存数据；无肝外疾病。主要终点是评估OS。结果报告为HR和95% CI。我们进行了meta回归分析以确定影响异质性的因素。我们分析了关键协变量，以预测这些因素的变化如何影响人力资源。结果：纳入6项研究。ST组的OS明显优于NST组，HR = 0.41 （95% CI: 0.32 ~ 0.52）。异质性高（I2 = 64.50%）。随着ST组患者术后行CT率的降低，两组间的差异减小(β = -1.28±0.67；P = 0.003)，异质性几乎为87.10%。基于meta回归的调整效应显示，ST组仅在术前和术后进行全身CT时，OS得到改善（HR 0.18, 95% CI: 0.08-0.40）。结论：在对全身CT有反应并接受术后全身CT的高选择性转移性PDAC患者中，ST可能与改善的OS相关。然而，纳入研究的高异质性和回顾性设计限制了得出明确结论的能力。

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Stage IV pancreatic ductal adenocarcinoma (PDAC) with synchronous liver metastasis: are there survival benefits in liver resection? A systematic review and meta-analysis

Objective

Metastatic PDAC has a very poor prognosis, and surgery has a limited role. The study aims to evaluate the OS of patients with PDAC and synchronous liver metastasis who undergo surgical therapy (ST) versus non-surgical therapies (NST).

Methods

We performed a random effects meta-analysis. Inclusion criteria were: PDAC histology; studies reporting technically resectable cases with liver metastasis and survival data; absence of extra-hepatic disease. The primary endpoint was to evaluate OS. Results were reported as HR and 95 % CI. We performed a meta-regression analysis to identify factors influencing heterogeneity. We analyzed key covariates in order to predict how changes in these factors affect HR.

Results

Six studies were included. The OS was significantly better in group ST than NST, with HR = 0.41 (95 % CI: 0.32–0.52). Heterogeneity was high (I² = 64.50 %). As the rate of patients who underwent postoperative CT in the ST group decreased, the difference between the two groups decreased (β = −1.28 ± 0.67; p = 0.003), with almost 87.10 % heterogeneity. The adjusted effect based on meta-regression showed an improved OS in ST group only when both pre- and post-operative systemic CT were administrated (HR 0.18, 95 % CI: 0.08–0.40).

Conclusions

In highly selected patients with metastatic PDAC who respond to systemic CT and receive post-operative systemic CT, ST could be associated with improved OS. However, the high heterogeneity and retrospective design of included studies limit the ability to draw definitive conclusions.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.