背景:小型回顾性研究表明,局部巩固治疗(LCT)可以改善寡转移型胰腺导管腺癌(PDAC)的生存率。然而,PDAC中不存在寡转移疾病(OMD)的统一定义;这阻碍了有意义的结论。
方法:使用PubMed进行系统的文献检索,WebofScience,对PDAC中OMD的定义和/或LCT的研究和方案进行了CochraneCENTRAL注册。主要终点是OMD的定义。协议水平被归类为共识(研究之间≥75%的一致性),公平协议(50%-74%),缺乏/协议差(<50%)。
结果:在筛选5374篇摘要后,对218项研究的全文进行了评估,其中76项被纳入定性综合。大多数研究是回顾性的(n=66,87%),两项是前瞻性研究,8项是研究方案.研究主要调查肝脏(n=38,51%)和肺转移(n=15,20%)。在整个研究中,不到一半(n=32,42%)报告了OMD的定义,44(58%)没有。参与仅限于单个器官(共识)。定义OMD的其他标准是病变数量(共识),转移部位(一致性差),转移大小(一致性差),治疗可能性(协议不良),和生物标志物反应(协议差)。肝脏OMD可能涉及三个或更少的病变(共识)和同步疾病(公平协议),而肺转移可能涉及两个或更少的病变和异时性疾病(共识)。绝大多数研究存在高偏倚风险或不包括任何对照组。
结论:OMD的定义没有被使用,或者在研究之间差异很大,这阻碍了研究之间的可比性,并强调了未满足的共识需求。本研究是一个多步骤过程的一部分,旨在就胰腺癌中的OMD达成跨学科共识。
BACKGROUND: Small retrospective series suggest that local consolidative treatment (LCT) may improve survival in oligometastatic pancreatic ductal adenocarcinoma (PDAC). However, no uniform definition of oligometastatic disease (OMD) in PDAC exists; this impedes meaningful conclusions.
METHODS: A systematic literature search using PubMed, Web of Science, and Cochrane CENTRAL registries for studies and protocols reporting on definitions and/or LCT of OMD in PDAC was performed. The primary endpoint was the definition of OMD. Levels of agreement were categorized as consensus (≥75% agreement between studies), fair agreement (50%-74%), and absent/poor agreement (<50%).
RESULTS: After screening of 5374 abstracts, the full text of 218 studies was assessed, of which 76 were included in the qualitative synthesis. The majority of studies were retrospective (n = 66, 87%), two were prospective studies and eight were study protocols. Studies investigated mostly liver (n = 38, 51%) and lung metastases (n = 15, 20%). Across studies, less than one-half (n = 32, 42%) reported a definition of OMD, while 44 (58%) did not. Involvement was limited to a single organ (consensus). Additional criteria for defining OMD were the number of lesions (consensus), metastatic site (poor agreement), metastatic size (poor agreement), treatment possibilities (poor agreement), and biomarker response (poor agreement). Liver OMD could involve three or fewer lesions (consensus) and synchronous disease (fair agreement), while lung metastases could involve two or fewer lesions and metachronous disease (consensus). The large majority of studies were at a high risk of bias or did not include any control groups.
CONCLUSIONS: Definitions of OMD were not used or varied widely between studies hampering across-study comparability and highlighting an unmet need for a consensus. The present study is part of a multistep process that aims to develop an interdisciplinary consensus on OMD in pancreatic cancer.