Adjuvant chemotherapy and outcomes in patients with nodal and resection margin‐negative pancreatic ductal adenocarcinoma: A systematic review and meta‐analysis

Abstract

Adjuvant chemotherapy (AC) following pancreatic carcinoma (PC) resection improves overall survival (OS). A systematic review identified 10 phase‐2/3 studies investigating AC in 3644 patients looking at the influence of nodal and resection status. AC significantly improved disease free survival, OS and 5‐year odds of death risk. There was greater survival benefit in patients PS 0 and with body/tail tumors. There was a nonsignificant effect in N − /N + patients on OS and no difference between R0/R1 patients.

Response to letter to the editor: The impact of the nodal status and resection margin on the effectiveness of adjuvant chemotherapy for pancreatic cancer: It calls for more careful evaluation

“…A recent ASCO clinical practice guidelines update on potentially curable PDAC has recommended that all patients with resected PDAC who have not received preoperative therapy should be offered 6 months of adjuvant chemotherapy, in the absence of medical or surgical contraindications . Our meta‐analysis supports the use of adjuvant treatment in resected PDAC with effects seemingly consistent in subgroups defined by nodal or resection margin status.…”

“…We thank Tan and colleagues for their letter relating to our published article . The Cochrane Handbook describes that heterogeneity can arise from multiple sources, and some of these sources may not be captured by statistical measures of heterogeneity (eg, clinical heterogeneity or methodological heterogeneity).…”

“…The Cochrane Handbook describes that heterogeneity can arise from multiple sources, and some of these sources may not be captured by statistical measures of heterogeneity (eg, clinical heterogeneity or methodological heterogeneity). As detailed in the second sentence of our statistical analysis section, we identified substantial clinical heterogeneity and, therefore, applied random effect modeling to all analyses, irrespective of statistical heterogeneity. This is consistent with Cochrane recommendations…”

“…As stated in the results section of our manuscript, studies published between January 1993 and January 2017 were included in this meta‐analysis. Data from the adjuvant studies by Uesaka et al and Neoptolemos et al (referred to in figures as Neoptolemos et al 2016, as at the time of the literature search, data were available only as an abstract presented at the 2016 American Society of Clinical Oncology [ASCO] annual meeting) were included in this meta‐analysis .…”

“…As stated in the results section of our manuscript, studies published between January 1993 and January 2017 were included in this meta‐analysis. Data from the adjuvant studies by Uesaka et al and Neoptolemos et al (referred to in figures as Neoptolemos et al 2016, as at the time of the literature search, data were available only as an abstract presented at the 2016 American Society of Clinical Oncology [ASCO] annual meeting) were included in this meta‐analysis . It was acknowledged in the discussion section that the study by Conroy et al, which investigated the effects of adjuvant modified 5‐fluorouracil/irinotecan/oxaliplatin (FOLFIRINOX) vs gemcitabine in 493 patients with resected pancreatic ductal adenocarcinoma (PDAC) was not included in this meta‐analysis, as it was not within the timeframe studied.…”