Published online Oct 15, 2022. doi: 10.4251/wjgo.v14.i10.1903
Peer-review started: June 26, 2022
First decision: July 25, 2022
Revised: August 5, 2022
Accepted: September 8, 2022
Article in press: September 8, 2022
Published online: October 15, 2022
Processing time: 110 Days and 6.3 Hours
Currently, 15 randomized controlled trials (RCTs) have been designed to investigate whether neoadjuvant therapy (NAT) benefits patients with resectable pancreatic adenocarcinoma (R-PA) compared to surgery alone. Five of them have acquired results so far; however, corresponding conclusions have not been obtained. We speculated that the reason for this phenomenon could be that some prognostic factors had proven to be adverse through upfront surgery curative patterns, but some of them were not regarded as independent baseline characteristics, which is important to obtaining comparability between the NAT and upfront surgery groups. This fact could cause bias and lead to the difference in the outcomes of RCTs. In this review, we collate data about risk factors (such as tumor size, resection margin, and lymph node status) influencing the prognoses of patients with R-PA from five RCTs and discuss the possible reasons for the varying outcomes.
Core Tip: In this review, we collate data about risk factors influencing the prognoses of patients with resectable pancreatic cancer from five randomized controlled trials (RCTs) and discuss the possible reasons for the varying outcomes. By comparing the overall survival of two RCTs, we speculated that neoadjuvant therapy might actually benefit patients with low-risk factors for long-term survival. Moreover, we address some suggestions for the RCTs in the future.