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Purpose <p>This study was designed to evaluate the comparative outcomes of neoadjuvant chemoradiotherapy (NACR) and neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC).</p> Methods <p>Systematic search of electronic data sources was conducted, and all randomised controlled trials (RCTs) investigating outcomes of NACR and NAC in patients with PDAC were considered. Surgical resection rate, R0 resection, radiological response to treatment, and 1–5&#xa0;years and overall survival were the evaluated outcome measures.</p> Results <p>Twenty-four RCTs reporting a total of 2273 patients who received NACR (<i>n</i> = 1152) and NAC (<i>n</i> = 1121) for PDAC were included. Both NACR and NAT were associated with comparable rate of partial response [11.8% (95% confidence interval [CI] 3.9–19.8) vs. 20.1% (95% CI 11.7–28.6)], stable disease [41.2% (95% CI 28–54.5%) vs. 47.1% (95% CI 30.3–63.8%)], or disease progression [17.3% (95% CI 4.1–30.5%) vs. 25.2% (95% CI 12.6–37.9%)] during treatment. The comparative meta-analyses demonstrated that there was no significant difference in surgical resection rate (68.9% vs. 71.5%, odds ratio [OR] 0.96; 95% CI 0.89–1.05, <i>p</i> = 0.39), R0 resection (70.7% vs. 64.2%, OR 1.04; 95% CI 0.90–1.20, <i>p</i> = 0.58), 1 year (71.3% vs. 72.4%, OR 0.99; 95% CI 0.81–1.20, <i>p</i> = 0.90), 3 years (21.9% vs. 21.4%, OR 0.93; 95% CI 0.68–1.29, <i>p</i> = 0.68), and overall survival (HR 0.79; 95% CI 0.61–1.01, <i>p</i> = 0.06) between NACR and NAC. Subgroup analyses on resectable or borderline resectable PDAC were consistent with the main analyses.</p> Conclusions <p>The meta-analysis of best available evidence (level 1a) demonstrates that NACR and NAC are associated with comparable surgical resection rate, R0 resection, and survival in patients with PDAC. The available evidence may be subject to type 2 error and future randomised evidence is needed.</p>

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Neoadjuvant Chemoradiotherapy Versus Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-analysis of Randomised Controlled Trials

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Shahin Hajibandeh,
  • Shahab Hajibandeh,
  • Jameel Alfarah,
  • Alicja Psica,
  • Syed Soulat Raza,
  • David C. Bartlett,
  • Bobby V. M. Dasari,
  • Ravi Marudanayagam,
  • Robert P. Sutcliffe,
  • Keith J. Roberts,
  • Nikolaos Chatzizacharias

摘要

Purpose

This study was designed to evaluate the comparative outcomes of neoadjuvant chemoradiotherapy (NACR) and neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

Systematic search of electronic data sources was conducted, and all randomised controlled trials (RCTs) investigating outcomes of NACR and NAC in patients with PDAC were considered. Surgical resection rate, R0 resection, radiological response to treatment, and 1–5 years and overall survival were the evaluated outcome measures.

Results

Twenty-four RCTs reporting a total of 2273 patients who received NACR (n = 1152) and NAC (n = 1121) for PDAC were included. Both NACR and NAT were associated with comparable rate of partial response [11.8% (95% confidence interval [CI] 3.9–19.8) vs. 20.1% (95% CI 11.7–28.6)], stable disease [41.2% (95% CI 28–54.5%) vs. 47.1% (95% CI 30.3–63.8%)], or disease progression [17.3% (95% CI 4.1–30.5%) vs. 25.2% (95% CI 12.6–37.9%)] during treatment. The comparative meta-analyses demonstrated that there was no significant difference in surgical resection rate (68.9% vs. 71.5%, odds ratio [OR] 0.96; 95% CI 0.89–1.05, p = 0.39), R0 resection (70.7% vs. 64.2%, OR 1.04; 95% CI 0.90–1.20, p = 0.58), 1 year (71.3% vs. 72.4%, OR 0.99; 95% CI 0.81–1.20, p = 0.90), 3 years (21.9% vs. 21.4%, OR 0.93; 95% CI 0.68–1.29, p = 0.68), and overall survival (HR 0.79; 95% CI 0.61–1.01, p = 0.06) between NACR and NAC. Subgroup analyses on resectable or borderline resectable PDAC were consistent with the main analyses.

Conclusions

The meta-analysis of best available evidence (level 1a) demonstrates that NACR and NAC are associated with comparable surgical resection rate, R0 resection, and survival in patients with PDAC. The available evidence may be subject to type 2 error and future randomised evidence is needed.