Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials.

Humans Neoadjuvant Therapy Pancreatic Neoplasms / mortality Randomized Controlled Trials as Topic Carcinoma, Pancreatic Ductal / mortality Pancreatectomy Bayes Theorem

Journal

BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685

Informations de publication

Date de publication:
03 Sep 2024
Historique:
received: 11 12 2023
revised: 22 05 2024
accepted: 03 07 2024
medline: 27 9 2024
pubmed: 27 9 2024
entrez: 27 9 2024
Statut: ppublish

Résumé

Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been established. The aim of this study was to compare long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma based on whether they received neoadjuvant treatment or underwent upfront surgery. A systematic review including randomized clinical trials on the overall survival outcomes between neoadjuvant treatment and upfront surgery in patients with resectable pancreatic ductal adenocarcinoma was conducted up to 1 August 2023 from PubMed, MEDLINE and Web of Science databases. Patient-level survival data was extracted and reconstructed from available Kaplan-Meier curves. A frequentist one-stage meta-analysis was employed, using Cox-based models and a non-parametric method (restricted mean survival time), to assess the difference in overall survival between groups. A Bayesian meta-analysis was also conducted. Five randomized clinical trials comprising 625 patients were included. Among patients with resectable pancreatic ductal adenocarcinoma, neoadjuvant treatment was not significantly associated with a reduction in the hazard of death compared with upfront surgery (shared frailty HR 0.88, 95% c.i. 0.72 to 1.08, P = 0.223); this result was consistent in the non-parametric restricted mean survival time model (+2.41 months, 95% c.i. -1.22 to 6.04, P < 0.194), in the sensitivity analysis that excluded randomized clinical trials with a high risk of bias (shared frailty HR 0.91 (95% c.i. 0.72 to 1.15; P = 0.424)) and in the Bayesian analysis with a posterior shared frailty HR of 0.86 (95% c.i. 0.70 to 1.05). Neoadjuvant treatment does not demonstrate a survival advantage over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma.

Sections du résumé

BACKGROUND BACKGROUND
Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been established. The aim of this study was to compare long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma based on whether they received neoadjuvant treatment or underwent upfront surgery.
METHODS METHODS
A systematic review including randomized clinical trials on the overall survival outcomes between neoadjuvant treatment and upfront surgery in patients with resectable pancreatic ductal adenocarcinoma was conducted up to 1 August 2023 from PubMed, MEDLINE and Web of Science databases. Patient-level survival data was extracted and reconstructed from available Kaplan-Meier curves. A frequentist one-stage meta-analysis was employed, using Cox-based models and a non-parametric method (restricted mean survival time), to assess the difference in overall survival between groups. A Bayesian meta-analysis was also conducted.
RESULTS RESULTS
Five randomized clinical trials comprising 625 patients were included. Among patients with resectable pancreatic ductal adenocarcinoma, neoadjuvant treatment was not significantly associated with a reduction in the hazard of death compared with upfront surgery (shared frailty HR 0.88, 95% c.i. 0.72 to 1.08, P = 0.223); this result was consistent in the non-parametric restricted mean survival time model (+2.41 months, 95% c.i. -1.22 to 6.04, P < 0.194), in the sensitivity analysis that excluded randomized clinical trials with a high risk of bias (shared frailty HR 0.91 (95% c.i. 0.72 to 1.15; P = 0.424)) and in the Bayesian analysis with a posterior shared frailty HR of 0.86 (95% c.i. 0.70 to 1.05).
CONCLUSION CONCLUSIONS
Neoadjuvant treatment does not demonstrate a survival advantage over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma.

Identifiants

DOI: 10.1093/bjsopen/zrae087 PMID: 39329454
pubmed: 39329454
pii: 7779636
doi: 10.1093/bjsopen/zrae087
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review Comparative Study

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

Auteurs

Daniel Aliseda (D)

HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
ORCID: 0000-0002-5025-6069

Pablo Martí-Cruchaga (P)

HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.

Gabriel Zozaya (G)

HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.

Nuria Blanco (N)

HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.

Mariano Ponz (M)

Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
Department of Oncology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.

Ana Chopitea (A)

Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
Department of Oncology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.

Javier Rodríguez (J)

Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
Department of Oncology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.

Eduardo Castañón (E)

Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
Department of Oncology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.

Fernando Pardo (F)

HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.

Fernando Rotellar (F)

HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
ORCID: 0000-0002-6557-0712

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Neoadjuvant therapy versus upfront surgery in...
questionsmedicales.fr › Thérapeutique › Association thérapeutique › Traitement néoadjuvant › Neoadjuvant therapy versus upfront surgery in...
questionsmedicales.fr › Maladies endocriniennes › Tumeurs des glandes endocrines › Tumeurs du pancréas › Neoadjuvant therapy versus upfront surgery in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Neoadjuvant therapy versus upfront surgery in...
questionsmedicales.fr › Maladies endocriniennes › Tumeurs des glandes endocrines › Tumeurs du pancréas › Carcinome du canal pancréatique › Neoadjuvant therapy versus upfront surgery in...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Pancréatectomie › Neoadjuvant therapy versus upfront surgery in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Théorème de Bayes › Neoadjuvant therapy versus upfront surgery in...