局部胰腺管腺癌（PDAC）患者最好通过手术切除原发肿瘤和系统化疗治疗，这比任何一种单一疗法都提供更长的总生存期（OS）。然而，大多数患者由于微小转移性疾病而出现疾病复发。尽管目前还存在一些争议，但是已经有相当多的研究关注新辅助治疗在可手术的各种形式的PDAC中的作用。虽然联合辅助化疗仍然是可手术PDAC患者的标准护理方式，但新辅助化疗似乎能够在那些具有边缘可切除疾病的患者中提高OS，而不必增加切除率。此外，大约20%的非转移性PDAC患者可能会在诱导联合化疗的4-6个月后进行切除手术，即使没有明显的放射学反应，也能够导致该组患者的OS结果改善。需要更好地了解不同类型治疗的不同分子和生物学反应，以便实现特定治疗方案的最优序列以进一步改善OS。在本综述中，我们描述了对PDAC的不同临床阶段的当前治疗策略，并讨论了这些发展，这些发展可能通过整合癌症的基本临床和分子特征来确定多模式治疗的最优序列。© 2023 Springer Nature有限公司。

Patients with localized pancreatic ductal adenocarcinoma (PDAC) are best treated with surgical resection of the primary tumour and systemic chemotherapy, which provides considerably longer overall survival (OS) durations than either modality alone. Regardless, most patients will have disease relapse owing to micrometastatic disease. Although currently a matter of some debate, considerable research interest has been focused on the role of neoadjuvant therapy for all forms of resectable PDAC. Whilst adjuvant combination chemotherapy remains the standard of care for patients with resectable PDAC, neoadjuvant chemotherapy seems to improve OS without necessarily increasing the resection rate in those with borderline-resectable disease. Furthermore, around 20% of patients with unresectable non-metastatic PDAC might undergo resection following 4-6 months of induction combination chemotherapy with or without radiotherapy, even in the absence of a clear radiological response, leading to improved OS outcomes in this group. Distinct molecular and biological responses to different types of therapies need to be better understood in order to enable the optimal sequencing of specific treatment modalities to further improve OS. In this Review, we describe current treatment strategies for the various clinical stages of PDAC and discuss developments that are likely to determine the optimal sequence of multimodality therapies by integrating the fundamental clinical and molecular features of the cancer.© 2023. Springer Nature Limited.