Systemic neoadjuvant chemotherapy in modern pancreatic cancer treatment: a systematic review and meta-analysis.
Cancer
Neoadjuvant
Pancreas
Surgery
Journal
Annals of the Royal College of Surgeons of England
ISSN: 1478-7083
Titre abrégé: Ann R Coll Surg Engl
Pays: England
ID NLM: 7506860
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
pubmed:
16
7
2019
medline:
19
9
2019
entrez:
16
7
2019
Statut:
ppublish
Résumé
Pancreatic ductal adenocarcinoma remains a disease with a poor prognosis despite advances in surgery and systemic therapies. Neoadjuvant therapy strategies are a promising alternative to adjuvant chemotherapy. However, their role remains controversial. This meta-analysis aims to clarify the benefits of neoadjuvant therapy in resectable pancreatic ductal adenocarcinoma. Eligible studies were identified from MEDLINE, Embase, Web of Science and the Cochrane Library. Studies comparing neoadjuvant therapy with a surgery first approach (with or without adjuvant therapy) in resectable pancreatic ductal adenocarcinoma were included. The primary outcome assessed was overall survival. A random-effects meta-analysis was performed, together with pooling of unadjusted Kaplan-Meier curve data. A total of 533 studies were identified that analysed the effect of neoadjuvant therapy in pancreatic ductal adenocarcinoma. Twenty-seven studies were included in the final data synthesis. Meta-analysis suggested beneficial effects of neoadjuvant therapy with prolonged survival compared with a surgery-first approach, (hazard ratio 0.72, 95% confidence interval 0.69-0.76). In addition, R0 resection rates were significantly higher in patients receiving neoadjuvant therapy (relative risk 0.51, 95% confidence interval 0.47-0.55). Individual patient data analysis suggested that overall survival was better for patients receiving neoadjuvant therapy ( Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change.
Sections du résumé
BACKGROUND
BACKGROUND
Pancreatic ductal adenocarcinoma remains a disease with a poor prognosis despite advances in surgery and systemic therapies. Neoadjuvant therapy strategies are a promising alternative to adjuvant chemotherapy. However, their role remains controversial. This meta-analysis aims to clarify the benefits of neoadjuvant therapy in resectable pancreatic ductal adenocarcinoma.
METHODS
METHODS
Eligible studies were identified from MEDLINE, Embase, Web of Science and the Cochrane Library. Studies comparing neoadjuvant therapy with a surgery first approach (with or without adjuvant therapy) in resectable pancreatic ductal adenocarcinoma were included. The primary outcome assessed was overall survival. A random-effects meta-analysis was performed, together with pooling of unadjusted Kaplan-Meier curve data.
RESULTS
RESULTS
A total of 533 studies were identified that analysed the effect of neoadjuvant therapy in pancreatic ductal adenocarcinoma. Twenty-seven studies were included in the final data synthesis. Meta-analysis suggested beneficial effects of neoadjuvant therapy with prolonged survival compared with a surgery-first approach, (hazard ratio 0.72, 95% confidence interval 0.69-0.76). In addition, R0 resection rates were significantly higher in patients receiving neoadjuvant therapy (relative risk 0.51, 95% confidence interval 0.47-0.55). Individual patient data analysis suggested that overall survival was better for patients receiving neoadjuvant therapy (
CONCLUSIONS
CONCLUSIONS
Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change.
Identifiants
pubmed: 31304767
doi: 10.1308/rcsann.2019.0060
pmc: PMC6667953
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
453-462Références
J Clin Oncol. 2017 Feb 10;35(5):515-522
pubmed: 27621388
ANZ J Surg. 2018 Mar;88(3):E167-E172
pubmed: 28318082
World J Gastroenterol. 2007 Jun 7;13(21):2945-51
pubmed: 17589944
Am J Surg. 2012 Feb;203(2):132-9
pubmed: 21824596
J Surg Oncol. 2012 Jul 1;106(1):111-8
pubmed: 22311829
Oncotarget. 2017 Jul 18;8(29):47831-47840
pubmed: 28599299
J Gastrointest Surg. 2015 Oct;19(10):1802-12
pubmed: 26224039
Ann Surg Oncol. 2001 Dec;8(10):758-65
pubmed: 11776488
Ann Surg. 2015 Jan;261(1):12-7
pubmed: 25599322
Medicine (Baltimore). 2015 Sep;94(39):e1647
pubmed: 26426657
N Engl J Med. 2006 Jul 6;355(1):11-20
pubmed: 16822992
Pancreas. 2009 Apr;38(3):282-8
pubmed: 19142173
J Clin Oncol. 2009 Apr 10;27(11):1806-13
pubmed: 19273710
Ann Surg Oncol. 2006 Jan;13(1):66-74
pubmed: 16372154
Arch Surg. 1992 Nov;127(11):1335-9
pubmed: 1359851
Cancer Biol Ther. 2005 May;4(5):548-54
pubmed: 15846069
J Am Coll Surg. 2007 Mar;204(3):347-55
pubmed: 17324767
Am J Surg. 1993 Jan;165(1):68-72; discussion 72-3
pubmed: 8380315
Int J Radiat Oncol Biol Phys. 2013 Dec 1;87(5):1007-15
pubmed: 24267969
PLoS Med. 2009 Jul 21;6(7):e1000100
pubmed: 19621070
BMC Med Res Methodol. 2012 Feb 01;12:9
pubmed: 22297116
HPB (Oxford). 2006;8(5):365-8
pubmed: 18333089
Br J Surg. 2017 Oct;104(11):1433-1442
pubmed: 28628947
J Clin Oncol. 1997 Mar;15(3):928-37
pubmed: 9060530
World J Surg. 2007 May;31(5):1142-51
pubmed: 17354030
Lancet. 2017 Mar 11;389(10073):1011-1024
pubmed: 28129987
Cancer. 2011 May 15;117(10):2044-9
pubmed: 21523715
Surgery. 2016 Oct;160(4):1080-1096
pubmed: 27522556
World J Surg. 1997 Feb;21(2):195-200
pubmed: 8995078
J Natl Cancer Inst. 2014 Mar;106(3):dju011
pubmed: 24563516
Saudi J Gastroenterol. 2012 Mar-Apr;18(2):118-21
pubmed: 22421717
Ann Surg Oncol. 2010 Apr;17(4):981-90
pubmed: 20087786
Strahlenther Onkol. 2015 Jan;191(1):7-16
pubmed: 25252602
PLoS Med. 2010 Apr 20;7(4):e1000267
pubmed: 20422030
HPB (Oxford). 2014 Jan;16(1):34-9
pubmed: 23458131
Ann Surg Oncol. 2015 Apr;22(4):1168-75
pubmed: 25352267
Ann Surg Oncol. 2010 Feb;17(2):371-6
pubmed: 19851808
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
J Gastrointest Surg. 2014 Jan;18(1):16-24; discussion 24-5
pubmed: 24241967
Eur J Surg Oncol. 2017 Sep;43(9):1711-1717
pubmed: 28688722
J Am Coll Surg. 2014 Jul;219(1):111-20
pubmed: 24856952
Ann Surg. 2008 Dec;248(6):1014-22
pubmed: 19092346
Ann Surg Oncol. 2011 Mar;18(3):619-27
pubmed: 21213060
Langenbecks Arch Surg. 2015 May;400(4):477-85
pubmed: 25929828
Int J Surg. 2016 Oct;34:96-102
pubmed: 27573691
Anticancer Res. 2015 Apr;35(4):2401-9
pubmed: 25862906
JAMA. 2007 Jan 17;297(3):267-77
pubmed: 17227978
J Clin Oncol. 2012 Jun 1;30(16):1926-33
pubmed: 22529255
Surgery. 2016 Sep;160(3):714-24
pubmed: 27422328
Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):1128-33
pubmed: 18538501
Arch Surg. 2012 Aug;147(8):753-60
pubmed: 22911074
Cancer. 1980 Nov 1;46(9):1945-9
pubmed: 7427900
Trials. 2016 Mar 09;17(1):127
pubmed: 26955809
Am J Clin Oncol. 2003 Dec;26(6):543-9
pubmed: 14663369
Surgery. 2017 Mar;161(3):592-601
pubmed: 28341441