scholarly journals Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

BJS Open ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 52-61 ◽  
Author(s):  
S. Schorn ◽  
I. E. Demir ◽  
N. Samm ◽  
F. Scheufele ◽  
L. Calavrezos ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Ductal Adenocarcinoma ◽  
The Impact ◽  
Patterns Of Recurrence

The impact of neoadjuvant therapy on postoperative complication in pancreatic ductal adenocarcinoma - a systematic review with meta-analysis

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S79
Author(s):  
Stephan Schorn ◽  
Ihsan Ekin Demir ◽  
Elke Tieftrunk ◽  
Florian Scheufele ◽  
Lenka Calavrezos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complication ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Ductal Adenocarcinoma ◽  
The Impact

scholarly journals Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2132
Author(s):  
Bathiya Ratnayake ◽  
Alina Y. Savastyuk ◽  
Manu Nayar ◽  
Colin H. Wilson ◽  
John A. Windsor ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
Recurrence Rate ◽  
Locoregional Recurrence ◽  
Ductal Adenocarcinoma ◽  
Resectable Pancreatic Cancer ◽  
Recurrence Rates ◽  
Recurrence Patterns ◽  
Patterns Of Recurrence

Background: Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review seeks to compare sites and patterns of recurrence after resection between patients undergoing upfront surgery (US) or after NAT. Methods: The EMBASE, SCOPUS, PubMed, and Cochrane library databases were systematically searched to identify eligible studies that compare recurrence patterns between patients who had NAT (followed by resection) with those that had US. The primary outcome included site-specific recurrence. Results: 26 articles were identified including 4986 patients who underwent resection. Borderline resectable pancreatic cancer (BRPC, 47% 1074/2264) was the most common, followed by resectable pancreatic cancer (RPC 42%, 949/2264). The weighted overall recurrence rates were lower among the NAT group, 63.4% vs. 74% (US) (OR 0.67 (CI 0.52–0.87), p = 0.006). The overall weighted locoregional recurrence rate was lower amongst patients who received NAT when compared to US (12% vs. 27% OR 0.39 (CI 0.22–0.70), p = 0.004). In BRPC, locoregional recurrence rates improved with NAT (NAT 25.8% US 37.7% OR 0.62 (CI 0.44–0.87), p = 0.007). NAT was associated with a lower weighted liver recurrence rate (NAT 19.4% US 30.1% OR 0.55 (CI 0.34–0.89), p = 0.023). Lung and peritoneal recurrence rates did not differ between NAT and US cohorts (p = 0.705 and p = 0.549 respectively). NAT was associated with a significantly longer weighted mean time to first recurrence 18.8 months compared to US (15.7 months) (OR 0.18 (CI 0.05–0.32), p = 0.015). Conclusion: NAT was associated with lower overall recurrence rate and improved locoregional disease control particularly for those with BRPC. Although the burden of liver metastases was less, there was no overall effect upon distant metastatic disease.

scholarly journals Systemic neoadjuvant chemotherapy in modern pancreatic cancer treatment: a systematic review and meta-analysis

2019 ◽  
Vol 101 (7) ◽  
pp. 453-462 ◽  
Author(s):  
K Rangarajan ◽  
PH Pucher ◽  
T Armstrong ◽  
A Bateman ◽  
ZZR Hamady
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Confidence Interval ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Ductal Adenocarcinoma ◽  
Current Evidence ◽  
Surgery First

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 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 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 (P = 0.008). 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.

scholarly journals In the Era of the Leeds Protocol: A Systematic Review and A Meta-Analysis on the Effect of Resection Margins on Survival Among Pancreatic Ductal Adenocarcinoma Patients

2020 ◽  
Vol 109 (1) ◽  
pp. 11-17
Author(s):  
B. Kurlinkus ◽  
R. Ahola ◽  
E. Zwart ◽  
A. Halimi ◽  
B. S. Yilmaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Resection Margin ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Systematic Search ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Inverse Variance ◽  
The Impact

Background and Aims: A positive resection margin is considered to be a factor associated with poor prognosis after pancreatic ductal adenocarcinoma resection. However, analysis of the resection margin is dependent on the pathological slicing technique. The aim of this systematic review and meta-analysis was to study the impact of resection margin on the survival of pancreatic ductal adenocarcinoma patients whose specimens were analyzed using the axial slicing technique. Material and Methods: A systematic search in the PubMed, Cochrane, and Embase datasets covering the time period from November 2006 to January 2019 was performed. Only studies with axial slicing technique (Leeds Pathology Protocol or Royal College of Pathology Protocol) were included in the final database. Meta-analysis between the marginal distance and survival was performed with the Inverse Variance Method in RevMan. Results: The systematic search resulted in nine studies meeting the inclusion criteria. The median survival for a resection margin 0 mm ranged from 12.3 to 23.4 months, for resection margin <0.5 mm 16 months, for resection margin <1 mm ranged from 11 to 27.5 months, for resection margin <1.5 mm ranged from 16.9 to 21.2 months, and for resection margin >2 mm ranged from 53.9 to 63.1 months. Five studies were eligible for meta-analysis. The pooled multivariable hazard ratio favored resection margin ⩾1 mm (hazard ratio: 1.32 and 95% confidence interval: 1.03–1.68, p = 0.03). Conclusion: Resection margins ⩾1 mm seem to lead to better survival in pancreatic ductal adenocarcinoma patients than resection margin <1 mm. However, there is not enough data to evaluate the effect of oncologic therapy or to analyze the impact of other resection margin distances on survival.

Sign in / Sign up

Export Citation Format

Share Document