导管内乳头状粘液瘤源性胰腺癌切除术后的辅助治疗：一项系统回顾和荟萃分析

IF 9.6 1区医学 Q1 ONCOLOGY

Cancer treatment reviews Pub Date : 2025-05-22 DOI:10.1016/j.ctrv.2025.102969

Joseph R. Habib , Asad Saulat Fatimi , Omar Mahmud , Ingmar F. Rompen , Benedict Kinny-Köster , Lois A. Daamen , Jin He , I. Quintus Molenaar , Marco Del Chiaro , Christopher L. Wolfgang , Ammar A. Javed , Marc G. Besselink , for the PANC-PALS Consortium

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引用次数: 0

摘要

导管内乳头状粘液瘤（IPMN）衍生的胰腺癌的治疗是从胰腺上皮内肿瘤（PanIN）衍生的胰腺癌中推断出来的。然而，这些癌症在生物学和临床上是不同的，关于辅助治疗（AT）的作用的证据尚不清楚。本系统综述和荟萃分析的目的是巩固目前关于AT治疗ipmn源性胰腺癌的生存获益的证据。方法系统检索PubMed、Embase、Scopus、Web of Science和Cochrane CENTRAL数据库，检索时间为成立至2025年2月2日。研究报告了比较AT与单纯手术治疗ipmn源性胰腺癌的生存分析。偏倚风险采用纽卡斯尔-渥太华量表进行评估。使用通用的逆方差随机效应模型汇总风险比。结果本综述共纳入26项研究。所有的研究都是观察性的，16项具有低偏倚风险，10项具有高偏倚风险。在汇总多变量分析中，AT与总体OS获益无关（HR: 0.78[0.47, 1.28]）。在病理淋巴结阳性（pN1或pN2）疾病、晚期t期和总体AJCC肿瘤分期、CA19-9升高（>37 IU）和分化程度差的患者亚组中，AT与OS获益相关。结论：目前的数据表明，ipmn源性胰腺癌切除术后常规AT与OS获益无关，可能构成过度治疗。然而，具有高风险特征的患者，如大或高级别肿瘤、淋巴结疾病和CA19-9升高的患者可能受益于AT。

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Adjuvant therapy after resection of intraductal papillary mucinous neoplasm-derived pancreatic cancer: A systematic review and meta-analysis

Introduction

The management of intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer is extrapolated from pancreatic intraepithelial neoplasm (PanIN)-derived pancreatic cancer. However, these cancers are biologically and clinically distinct and evidence regarding the role of adjuvant therapy (AT) is unclear. The aim of this systematic review and meta-analysis was to consolidate current evidence regarding survival benefit of AT for IPMN-derived pancreatic cancer.

Methods

Systematic searches of the PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL databases were performed from inception to February 2nd, 2025. Studies that reported survival analyses comparing AT versus surgery alone for resected IPMN-derived pancreatic cancer were included. Risk of bias was assessed using the Newcastle-Ottawa scale. Hazard ratios were pooled using generic inverse-variance random-effects models.

Results

A total of 26 studies were included in this review. All studies were observational and 16 had low risk of bias while 10 had high risk of bias. AT was not associated with an OS benefit on pooled multivariable analysis (HR: 0.78 [0.47, 1.28]) in the total population. In subgroups of patients with pathology node-positive (pN1 or pN2) disease, advanced T-stage and overall AJCC tumor stage, elevated CA19-9 (>37 IU), and poor grade of differentiation, AT was associated with OS benefit.

Conclusions

Current data suggests that routine AT after resection of IPMN-derived pancreatic cancer is not associated with an OS benefit and may constitute overtreatment. However, patients with high-risk features such as large or high-grade tumors, nodal disease, and elevated CA19-9 may benefit from AT.

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来源期刊

Cancer treatment reviews 医学-肿瘤学

CiteScore

21.40

自引率

0.80%

发文量

109

审稿时长

13 days

期刊介绍： Cancer Treatment Reviews Journal Overview: International journal focused on developments in cancer treatment research Publishes state-of-the-art, authoritative reviews to keep clinicians and researchers informed Regular Sections in Each Issue: Comments on Controversy Tumor Reviews Anti-tumor Treatments New Drugs Complications of Treatment General and Supportive Care Laboratory/Clinic Interface Submission and Editorial System: Online submission and editorial system for Cancer Treatment Reviews