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Abstract：
BACKGROUND: Current treatment recommendations for resectable or borderline pancreatic carcinoma support upfront surgery and adjuvant therapy. However, neoadjuvant therapy (NT) seems to increase prognosis of pancreatic carcinoma and come to everyone\'s attention gradually. Randomized controlled trials offering comparison with the NT are lacking and optimal neoadjuvant treatment regimen still remains uncertain. This study aims to compare both treatment strategies for resectable or borderline resectable pancreatic cancer.
METHODS: The PRISMA checklist was used as a guide to systematically review relevant peer-reviewed literature reporting primary data analysis. We searched PubMed, Medline, EMBASE, Cochrane Datebase and related reviews for randomized controlled trials comparing neoadjuvant therapy with surgery first for resectable or borderline resectable pancreatic carcinoma. We estimated relative hazard ratios (HRs) for median overall survival and ratios risks (RRs) for microscopically complete (R0) resection among different neoadjuvant regimens and major complications. We assessed the effects of neoadjuvant therapy on R0 resection rate and median overall survival with Bayesian analysis.
RESULTS: Thirteen eligible articles were included. Eight studies performed comparison neoadjuvant therapy with surgery first, and R0 resection rate was recorded in seven studies. Compared with surgery first, neoadjuvant therapy did increase the R0 resection rate (RR = 1.53, I2 = 0%, P< 0.00001), there was a certain possibility that gemcitabine + cisplatin (Gem+Cis) + Radiotherapy was the most favorable in terms of the fact that there was no significant difference concerning the results from the individual studies. In direct comparison, four studies were included and estimated that Neoadjuvant therapy improved mOS compared with upfront surgery (HR 0.68, 95% CI 0.58-0.92; P = 0.012; I2 = 15%), after Bayesian analysis it seemed that regimen with Cisplatin/ Epirubicin then Gemcitabine/ Capecitabine (PEXG) was most likely the best with a relatively small sample size. The rate of major surgical complications was available for six studies and ranged from 11% to 56% with neoadjuvant therapy and 11% to 45% with surgery first. There was no significant difference between neoadjuvant therapy and surgery first, also with a high heterogeneity (RR = 0.96, 95%CI = 0.65-1.43; P = 0.85; I2 = 46%).
CONCLUSIONS: In conclusion neoadjuvant therapy might offer benefit over up-front surgery. Neoadjuvant therapy increased the R0 resection rate with gemcitabine + cisplatin + Radiotherapy that was the most favorable and improved mOS with Cisplatin/ Epirubicin then Gemcitabine/ Capecitabine (PEXG) that was most likely the best.
METHODS: The PRISMA checklist was used as a guide to systematically review relevant peer-reviewed literature reporting primary data analysis. We searched PubMed, Medline, EMBASE, Cochrane Datebase and related reviews for randomized controlled trials comparing neoadjuvant therapy with surgery first for resectable or borderline resectable pancreatic carcinoma. We estimated relative hazard ratios (HRs) for median overall survival and ratios risks (RRs) for microscopically complete (R0) resection among different neoadjuvant regimens and major complications. We assessed the effects of neoadjuvant therapy on R0 resection rate and median overall survival with Bayesian analysis.
RESULTS: Thirteen eligible articles were included. Eight studies performed comparison neoadjuvant therapy with surgery first, and R0 resection rate was recorded in seven studies. Compared with surgery first, neoadjuvant therapy did increase the R0 resection rate (RR = 1.53, I2 = 0%, P< 0.00001), there was a certain possibility that gemcitabine + cisplatin (Gem+Cis) + Radiotherapy was the most favorable in terms of the fact that there was no significant difference concerning the results from the individual studies. In direct comparison, four studies were included and estimated that Neoadjuvant therapy improved mOS compared with upfront surgery (HR 0.68, 95% CI 0.58-0.92; P = 0.012; I2 = 15%), after Bayesian analysis it seemed that regimen with Cisplatin/ Epirubicin then Gemcitabine/ Capecitabine (PEXG) was most likely the best with a relatively small sample size. The rate of major surgical complications was available for six studies and ranged from 11% to 56% with neoadjuvant therapy and 11% to 45% with surgery first. There was no significant difference between neoadjuvant therapy and surgery first, also with a high heterogeneity (RR = 0.96, 95%CI = 0.65-1.43; P = 0.85; I2 = 46%).
CONCLUSIONS: In conclusion neoadjuvant therapy might offer benefit over up-front surgery. Neoadjuvant therapy increased the R0 resection rate with gemcitabine + cisplatin + Radiotherapy that was the most favorable and improved mOS with Cisplatin/ Epirubicin then Gemcitabine/ Capecitabine (PEXG) that was most likely the best.
摘要：
背景：目前对可切除或交界性胰腺癌的治疗建议支持前期手术和辅助治疗。然而,新辅助治疗（NT）似乎增加了胰腺癌的预后，并逐渐引起了大家的关注。缺乏与NT比较的随机对照试验，最佳新辅助治疗方案仍不确定。本研究旨在比较两种可切除或临界可切除胰腺癌的治疗策略。
方法：使用PRISMA清单作为指南，系统地回顾报告主要数据分析的相关同行评审文献。我们搜索了PubMed,Medline,EMBASE,CochraneDatebase和随机对照试验的相关综述，比较新辅助治疗和手术治疗可切除或临界可切除的胰腺癌。我们估计了不同新辅助治疗方案和主要并发症中的中位总生存期的相对风险比（HRs）和显微镜下完全切除（R0）的风险比（RRs）。我们通过贝叶斯分析评估了新辅助治疗对R0切除率和中位总生存期的影响。
结果：纳入了13篇符合条件的文章。8项研究将新辅助治疗与手术进行了比较，在7项研究中记录了R0切除率。与先手术相比，新辅助治疗确实增加了R0切除率（RR=1.53，I2=0%，P<0.00001),有一定的可能性,吉西他滨+顺铂(Gem+Cis)+放疗是最有利的,这是因为各项研究的结果没有显著差异.直接比较,纳入了四项研究，估计新辅助治疗比前期手术改善了mOS（HR0.68，95％CI0.58-0.92；P=0.012；I2=15％），经过贝叶斯分析,在样本量相对较小的情况下,采用顺铂/表柔比星,然后采用吉西他滨/卡培他滨(PEXG)的方案似乎是最佳方案.主要手术并发症的发生率可用于六项研究，新辅助治疗的发生率为11％至56％，首次手术的发生率为11％至45％。新辅助治疗与先手术治疗无显著差异,也具有高度异质性(RR=0.96,95CI=0.65-1.43;P=0.85;I2=46%)。
结论：总之，新辅助治疗可能比前期手术更有益。新辅助治疗提高了吉西他滨+顺铂+放疗的R0切除率，这是最有利的，改善了顺铂/表柔比星的mOS，然后吉西他滨/卡培他滨（PEXG）最有可能是最好的。
方法：使用PRISMA清单作为指南，系统地回顾报告主要数据分析的相关同行评审文献。我们搜索了PubMed,Medline,EMBASE,CochraneDatebase和随机对照试验的相关综述，比较新辅助治疗和手术治疗可切除或临界可切除的胰腺癌。我们估计了不同新辅助治疗方案和主要并发症中的中位总生存期的相对风险比（HRs）和显微镜下完全切除（R0）的风险比（RRs）。我们通过贝叶斯分析评估了新辅助治疗对R0切除率和中位总生存期的影响。
结果：纳入了13篇符合条件的文章。8项研究将新辅助治疗与手术进行了比较，在7项研究中记录了R0切除率。与先手术相比，新辅助治疗确实增加了R0切除率（RR=1.53，I2=0%，P<0.00001),有一定的可能性,吉西他滨+顺铂(Gem+Cis)+放疗是最有利的,这是因为各项研究的结果没有显著差异.直接比较,纳入了四项研究，估计新辅助治疗比前期手术改善了mOS（HR0.68，95％CI0.58-0.92；P=0.012；I2=15％），经过贝叶斯分析,在样本量相对较小的情况下,采用顺铂/表柔比星,然后采用吉西他滨/卡培他滨(PEXG)的方案似乎是最佳方案.主要手术并发症的发生率可用于六项研究，新辅助治疗的发生率为11％至56％，首次手术的发生率为11％至45％。新辅助治疗与先手术治疗无显著差异,也具有高度异质性(RR=0.96,95CI=0.65-1.43;P=0.85;I2=46%)。
结论：总之，新辅助治疗可能比前期手术更有益。新辅助治疗提高了吉西他滨+顺铂+放疗的R0切除率，这是最有利的，改善了顺铂/表柔比星的mOS，然后吉西他滨/卡培他滨（PEXG）最有可能是最好的。
