Introduction Prognostic markers for overall survival (OS) in resected pancreatic ductal adenocarcinoma (PDAC) are well-established but remain unclear following neoadjuvant therapy (NAT). This systematic review and meta-analysis aimed to determine factors associated with OS following NAT in resected PDAC. Methods The PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL databases were systematically searched from inception till May 2024. Studies that reported univariable and multivariable hazard ratios (HRs) were included if patients underwent NAT and resection for localized PDAC. Study quality assessment was performed using the Newcastle-Ottawa scale. Meta-analysis was performed using generic inverse-variance random-effects models. Results Among 2,208 unique articles identified by the search, 92 were included in the meta-analysis. Eighty-five of these were of 'good' and 7 of 'poor' quality. The NAT regimen was described in 84 studies, of which 62 included patients treated with FOLFIRINOX (FFX). Margin status, nodal disease, AJCC T-stage, and normalization of CA19-9 after NAT were prognostic for OS, while age, sex, perineural invasion, baseline tumor size, and baseline CA19-9 were not. The test for subgroup differences between ypN-substages was not significant in the multivariable model. Neoadjuvant FFX was associated with better survival than other regimens. Conclusions This meta-analysis identified margin status, nodal disease, AJCC T-stage, and normalization of CA19-9 after NAT as prognostic factors for OS in patients with resected localized PDAC following NAT.

中文翻译：

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新辅助治疗和切除术后局限性胰腺导管腺癌的预后因素： 系统评价和 Meta 分析


引言 切除的胰腺导管腺癌 （PDAC） 总生存期 （OS） 的预后标志物已得到明确，但在新辅助治疗 （NAT） 后仍不清楚。本系统评价和荟萃分析旨在确定与切除的 PDAC 中 NAT 后 OS 相关的因素。方法 系统检索了 PubMed、Embase、Scopus、Web of Science 和 Cochrane CENTRAL 数据库，检索时间从建库到 2024 年 5 月。如果患者因局部 PDAC 接受 NAT 和切除术，则纳入报告单变量和多变量风险比 （HRs） 的研究。使用 Newcastle-Ottawa 量表进行研究质量评估。使用通用逆方差随机效应模型进行 Meta 分析。结果 在检索确定的 2,208 篇独特文章中，92 篇被纳入荟萃分析。其中 85 个质量为 “良好”，7 个为 “差” 质量。84 项研究描述了 NAT 方案，其中 62 项包括接受 FOLFIRINOX （FFX） 治疗的患者。切缘状态、淋巴结疾病、AJCC T 分期和 NAT 后 CA19-9 恢复正常是 OS 的预后，而年龄、性别、神经周围浸润、基线肿瘤大小和基线 CA19-9 则不是。在多变量模型中，ypN 亚阶段之间亚组差异的检验不显著。新辅助 FFX 比其他方案具有更好的生存率。结论 本荟萃分析确定切缘状态、淋巴结疾病、AJCC T 分期和 NAT 后 CA19-9 正常化是 NAT 后切除的局部 PDAC 患者 OS 的预后因素。