PreoperativeNeoadjuvant Therapy in Pancreatic Cancer A Systematic Review and Meta-analysis of Response and Resection Percentages 英文参考文献.docVIP

Preoperative/NeoadjuvantTherapyinPancreaticCancer: ASystematicReviewandMeta-analysisofResponseand ResectionPercentages SonjaGillen1,TiborSchuster2,ChristianMeyerzumBu¨schenfelde3,HelmutFriess1,Jo¨rgKleeff1,4* 1Department of Surgery, Technische Universita¨t Mu¨nchen, Munich, Germany, 2Institute of Medical Statistics and Epidemiology, Technische Universita¨t Mu¨nchen, Munich,Germany,3DepartmentofHematologyandOncology,TechnischeUniversita¨t Mu¨nchen,Munich,Germany,4CenterofCancerSystemsBiology,Departmentof Medicine,CaritasSt.Elizabeth’sMedicalCenter,TuftsUniversitySchoolofMedicine,Boston,Massachusetts,UnitedStatesofAmerica Abstract Background:Pancreaticcancerhasanextremelypoorprognosisandprolongedsurvivalisachievedonlybyresectionwith macroscopic tumor clearance. There is a strong rationale for a neoadjuvant approach, since a relevant percentage of pancreaticcancerpatientspresentwithnon-metastaticbutlocallyadvanceddiseaseandmicroscopicincompleteresections are common. The objective of the present analysis was to systematically review studies concerning the effects of neoadjuvanttherapyontumorresponse,toxicity,resection,andsurvivalpercentagesinpancreaticcancer. Methods and Findings: Trials were identified by searching MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1966 to December 2009 as well as through reference lists of articles and proceedings of major meetings.Retrospectiveandprospectivestudiesanalyzingneoadjuvantradiochemotherapy,radiotherapy,orchemother- apyofpancreaticcancerpatients,followedbyre-staging,andsurgicalexploration/resectionwereincluded.Tworeviewers independentlyextracteddataandassessedstudyquality.Pooledrelativerisksand95%confidenceintervalswerecalculated usingrandom-effectsmodels.Primaryoutcomemeasureswereproportionsoftumorresponsecategoriesandpercentages ofexplorationandresection.Atotalof111studies(n=4,394)including56phaseI–IItrialswereanalyzed.Amedianof31 (interquartilerange[IQR]19–46)patientsperstudywereincluded.