背景:改善的全身治疗使胰腺导管腺癌(PDAC)切除术后的长期(≥5年)总生存期(LTS)越来越普遍。然而,缺乏对PDAC切除术后LTS预测因素的系统评价.
方法:PubMed,Embase,Scopus,和CochraneCENTRAL数据库从开始到2023年3月进行了系统搜索。包括报告与LTS相关因素的实际生存数据(基于随访而非生存分析估计)的研究。采用随机效应模型进行Meta分析,采用纽卡斯尔-渥太华量表(NOS)衡量研究质量。
结果:对27,091例接受PDAC手术切除的患者(LTS:2,132,非LTS:24,959)的25项研究进行了荟萃分析。根据20项研究,LTS患者的中位比例为18.32%(IQR12.97-21.18%)。LTS的预测因素包括性别,体重指数(BMI),术前CA19-9、CEA、和白蛋白,中性粒细胞-淋巴细胞比率,肿瘤分级,AJCC阶段,淋巴血管和神经周浸润,病理性T分期,结节性疾病,转移性疾病,边距状态,辅助治疗,血管切除术,手术时间,手术失血,围手术期输血。大多数文章都收到了“好”的NOS评估,表明偏见的风险是可以接受的。
结论:我们的荟萃分析汇集了文献中的所有真实随访数据,以量化PDAC切除术后预后因素与LTS之间的关联。虽然似乎有证据表明风险之间存在复杂的相互作用,肿瘤生物学,患者特征,和管理相关因素,没有单一参数可以预测PDAC切除术后的LTS。
BACKGROUND: Improved systemic therapy has made long term (≥ 5 years) overall survival (LTS) after resection of pancreatic ductal adenocarcinoma (PDAC) increasingly common. However, a systematic
review on predictors of LTS following resection of PDAC is lacking.
METHODS: The PubMed, Embase, Scopus, and Cochrane CENTRAL databases were systematically searched from inception until March 2023. Studies reporting actual survival data (based on follow-up and not survival analysis estimates) on factors associated with LTS were included. Meta-analyses were conducted by using a random effects model, and study quality was gauged by using the Newcastle-Ottawa Scale (NOS).
RESULTS: Twenty-five studies with 27,091 patients (LTS: 2,132, non-LTS: 24,959) who underwent surgical resection for PDAC were meta-analyzed. The median proportion of LTS patients was 18.32% (IQR 12.97-21.18%) based on 20 studies. Predictors for LTS included sex, body mass index (BMI), preoperative levels of CA19-9, CEA, and albumin, neutrophil-lymphocyte ratio, tumor grade, AJCC stage, lymphovascular and perineural invasion, pathologic T-stage, nodal disease, metastatic disease, margin status, adjuvant therapy, vascular resection, operative time, operative blood loss, and perioperative blood transfusion. Most articles received a \"good\" NOS assessment, indicating an acceptable risk of bias.
CONCLUSIONS: Our meta-analysis pools all true follow up data in the literature to quantify associations between prognostic factors and LTS after resection of PDAC. While there appears to be evidence of a complex interplay between risk, tumor biology, patient characteristics, and management related factors, no single parameter can predict LTS after the resection of PDAC.