Abstract
There is a strong rationale and many theoretical advantages for neoadjuvant therapy in pancreatic cancer (PC). However, study results have varied significantly. In this study, a systematic review and meta‐analysis of prospective studies were performed in order to evaluate safety and effectiveness of neoadjuvant therapy in PC. Thirty‐nine studies were selected (n = 1458 patients), with 14 studies focusing on patients with resectable disease (group 1), and 19 studies focusing on patients with borderline resectable and locally advanced disease (group 2). Neoadjuvant chemotherapy was administered in 97.4% of the studies, in which 76.9% was given radiotherapy and 74.4% administered with chemoradiation. The complete and partial response rate was 3.8% and 20.9%. The incidence of grade 3/4 toxicity was 11.3%. The overall resection rate after neoadjuvant therapy was 57.7% (group 1: 73.0%, group 2: 40.2%). The R0 resection rate was 84.2% (group 1: 88.2%, group 2: 79.4%). The overall survival for all patients was 16.79 months (resected 24.24, unresected 9.81; group 1: 17.76, group 2: 16.20). Our results demonstrate that neoadjuvant therapy has not been proven to be beneficial and should be considered with caution in patients with resectable PC. Patients with borderline resectable or locally advanced disease may benefit from neoadjuvant therapy, but further research is needed.
Highlights
Despite advances in the understanding of pancreatic cancer (PC) carcinogenesis and therapeutic agents, PC remains one of the most lethal malignancies, with an overall 5-year survival rate of approximately 5% [1, 2]
Due to the aggressive growth pattern and differing definitions of tumor involvement, microscopic involvement of the resection margin (R1) occurred in 0–83% of the resected patients; resection margin was proven to be one of the most important factors related to the prognostic outcome of patients resected for PC, positive resection margin usually resulted in higher risk of local recurrence and distant metastasis [7]
Repeated reports or studies that did not focus on tumor response, surgical procedure, and long-term survival were excluded
Summary
Despite advances in the understanding of pancreatic cancer (PC) carcinogenesis and therapeutic agents, PC remains one of the most lethal malignancies, with an overall 5-year survival rate of approximately 5% [1, 2]. Due to anatomical characteristics and nonspecific symptoms, early diagnosis of pancreatic cancer is very rare; only 15–20% of patients undergo resection, while the remaining 80–85% of patients are diagnosed with metastatic or locally advanced disease, in which palliative therapies, such as chemotherapy and radiation, are the only treatment options [5, 6]. For those patients who undergo resection, the prognosis remains poor owing to the high rate of local recurrence and/or distant metastasis. The adjuvant chemotherapy has been established as a standard treatment following surgical resections, based
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