Limited benefits of neoadjuvant therapy on R0 resection rate and overall survival in patients with resectable or...

A review of randomized controlled trials (RCTs) was conducted to assess the efficacy of neoadjuvant therapy for pancreatic ductal adenocarcinoma (PDAC). In this meta-analysis, neoadjuvant therapy was associated with a modest improvement in the R0 resection rate in patients with resectable PDAC (OR = 1.79, 95% CI: 1.13-2.83, p = 0.01), irrespective of the specific neoadjuvant chemotherapy regimen employed. However, among a specific subset of patients, the application of radiomics analysis before neoadjuvant chemotherapy may facilitate further improvements in R0 resection rates in resectable PDAC. Differences in tumor microenvironments may underlie variations in radiomic features and differential responses to neoadjuvant therapy. In the meta-analysis, neoadjuvant therapy such as the regimen with oxaliplatin, irinotecan, folinic acid, and fluorouracil (FOLFIRINOX) significantly improved the R0 resection rate (OR = 9.34, 95% CI = 4.05-21.50, p < 0.00001) and prognosis in patients with borderline resectable PDAC. However, the toxicity of the FOLFIRINOX regimen should be acknowledged. More phase III RCTs should be conducted to assess the efficacy of neoadjuvant chemotherapy accurately. The development of targeted immunotherapy, radiomics analysis, novel vascular resection methods, and denervation treatments may further improve the prognosis of patients with PDAC.