The Role And Value Of Neoadjuvant Therapy For Resectable Pancretic Cancer: A Meta-analysis And Systematic Review

Objective:The significance of resectable pancreatic cancer(RPC)neoadjuvant therapy(NAT)has been controversial.Method:PubMed,Embase,Cochrane Library,ASCO,ESMO and other databases were searched for a systematic review and meta analysis of clinical studies on RPC neoadjuvant therapy.The search time is January 1,2000 solstice March 31,2019.Results:A total of 22 studies were included,including 3359 RPC patients.14 studies were prospective and 8 studies were retrospective,including 1RCT,11 phase II clinical trials,8 case-control studies and 2 cohort studies.All patients were treated with NAT.Six(27.3%)studies were treated with chemotherapy alone,six were treated with monotherapy,13 were treated with chemotherapy in combination with NAT,and six(72.7%)were treated with chemotherapy in combination with radiotherapy in combination with NAT.Meta analysis results showed that the complete response rate of neoadjuvant therapy was 4%(95%CI: 1%-9%),partial response rate was 10%(95%CI: 5%-16%),disease stability rate was 65%(95%CI: 56-72%),and disease progression rate was 18%(95%CI: 3%-33%).The incidence of grade 3/4 toxicity was 29%(95% CI: 14%-46%).The total resection rate after neoadjuvant therapy was 74%,and the R0 resection rate was 65%,accounting for 88% of the resected patients.The positive rate of lymph nodes was 33%(95% CI: 25%-41%).Postoperative recurrence rate was 48%(95% CI: 33%-62%).The incidence of perioperative complications was 19%(95% CI: 8%-32%).Mortality was 0%(95%CI: 0%-1%).The overall survival was 23.64 months(26.52 months resected and 9.62 months unresected).Conclusion:Neoadjuvant therapy improves the R0 resection rate,does not increase the perioperative complications,and reduces the incidence of lymph node positive rate,so we can give priority to neoadjuvant therapy under the same survival conditions.However,large samples need to be verified by controlled trials at any time.