Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients

World Journal of Surgical Oncology

Research

Eileen M. O’Reilly¹  Nicholas A. Hein²  Lynette M. Smith²  Nathan Bahary³  Chandrakanth Are⁴  Mashaal Dhir⁵  Gautam K. Malhotra⁶  Davendra P.S. Sohal⁷ 

[1] David M. Rubenstein Center for Pancreatic Cancer, Memorial Sloan Kettering Cancer Center, 10065, New York, NY, USA;Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 68198, Omaha, NE, USA;Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh Medical Center, 15232, Pittsburgh, PA, USA;Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, 98198, Omaha, NE, USA;Department of Surgery/Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, 68198, Omaha, NE, USA;Department of Surgery, SUNY Upstate Medical University, 13210, Syracuse, NY, USA;Department of Surgery, University of Nebraska Medical Center, 98198, Omaha, NE, USA;Division of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, 44195, Cleveland, OH, USA;

关键词: Pancreatic cancer;    Pancreatic adenocarcinoma;    Neoadjuvant therapy;    Outcomes;    Survival;   

DOI  :  10.1186/s12957-017-1240-2

 received in 2017-06-11, accepted in 2017-08-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundRecent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed.MethodsPubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched.ResultsA total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0–16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively.ConclusionsThe current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.

【 授权许可】

CC BY   
© The Author(s). 2017

【 图 表 】

Fig. 2