TP6.1.3 Bayesian Network Meta-Analysis of Upfront Surgery Versus Neoadjuvant Therapy for Potentially Resectable Pancreatic Ductal Adenocarcinoma

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Abstract Aims To compare upfront surgery and neoadjuvant treatment strategies for potentially resectable PDAC. Methods PubMed, MEDLINE, Embase, Cochrane Database and Cochrane Databases were searched for studies comparing neoadjuvant and upfront surgery. A Bayesian network meta-analysis was conducted using the Markov chain Monte Carlo method to better handle the heterogeneity of existing studies. Convergence was assessed using the Brooks-Gelman-Rubin method. In accordance with NICE guidelines inconsistency was measured by comparing deviance residuals and DIC statistic in fitted consistency and inconsistency models. Cochrane Collaboration’s risk-of-bias, ROBINS-I and GRADE tools were used to assess the quality of included trials. Results 25 studies were included (n = 32,921). Aggregate rate (AR) of R0 was marginally higher with neoadjuvant therapy (0.7389 versus 0.7306, O.R 1.12, 95% CI 0.60-2.08). AR of 1,2,3,4 and 5-year survival were higher with neoadjuvant therapy (1-year survival: 0.8109 versus 0.6403, O.R: 2.12, 95% CI: 1.59-2.93; 2-year survival: 0.5135 versus 0.3002, O.R: 1.65 95%, CI: 1.16-2.34; 3-year survival: NAT 0.3151 versus 0.2147, O.R: 1.50, 95% CI: 1.10-2.04; 4-year survival: 0.2114 versus 0.1647 O.R: 1.57, 95% CI: 0.80-2.99; 5-year survival: 0.2118 versus 0.1736, O.R: 1.65, 95% CI: 0.68-3.73). Multimodal treatment was the key determinant of optimal outcome. Conclusion Considering the flaws in the existing evidence neither treatment pathway is conclusively superior at population level analysis. Receipt of multimodal treatment at individual level within either pathway optimises outcomes. This study demonstrates the importance of developing statistical methods that better engage with system complexity and uncertainty to move towards more personalised predictive medicine to support decision-making.

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Pretraining has recently greatly promoted the development of natural language processing (NLP)
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【要点】：通过贝叶斯网络元分析比较了胰腺导管腺癌患者 upfront手术与术前新辅助治疗的效果，发现新辅助治疗在五年生存率上略占优势，但两种治疗策略在人群水平上均无明确优越性，个性化多模式治疗是优化结果的关键。

【方法】：使用PubMed、MEDLINE、Embase、Cochrane数据库等资源搜集相关研究，采用贝叶斯网络元分析方法，并使用Markov链蒙特卡洛方法处理研究间的异质性。

【实验】：纳入了25项研究（共32,921名患者），通过Brooks-Gelman-Rubin方法评估收敛性，NICE指南评估不一致性，使用Cochrane协作网的偏倚风险、ROBINS-I和GRADE工具评估试验质量。结果显示新辅助治疗组的R0切除率略高，1至5年生存率均高于 upfront手术组，但多模式治疗是决定最佳结果的关键因素。