Adjuvant Chemotherapy in the Treatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas: Systematic Review and Meta‐Analysis

Chong, Eric; Ratnayake, B.; Dasari, B.; Loveday, Benjamin; Siriwardena, Ajith K.; Pandanaboyana, Sanjay

doi:10.1007/s00268-021-06309-8

Cited by 10 publications

(6 citation statements)

References 51 publications

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“…Recent studies including a meta-analysis suggested no major survival benefit with adjuvant chemotherapy; however, all the included studies are retrospective in nature. 23,25 Such a fundamental decision in patient management, however, will require a prospective randomized controlled trial of surgery alone versus surgery with adjuvant chemotherapy and to be adequately powered to answer this question. [26][27][28][29] Significant advances in molecular subtyping of PDAC have identified distinct subtypes of PDAC with particular characteristics in tumor biology.…”

Section: Discussionmentioning

confidence: 99%

“…The recent European guidelines, however, recommend adjuvant chemotherapy for adenocarcinoma arising IPMN with or without nodal disease. Recent studies including a meta-analysis suggested no major survival benefit with adjuvant chemotherapy; however, all the included studies are retrospective in nature 23,25 . Such a fundamental decision in patient management, however, will require a prospective randomized controlled trial of surgery alone versus surgery with adjuvant chemotherapy and to be adequately powered to answer this question 26–29 .…”

Section: Discussionmentioning

confidence: 99%

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Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment

Lucocq,

Hawkyard,

Robertson

et al. 2023

Annals of Surgery

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Objective: This international multicentre cohort study aims to identify recurrence patterns and treatment of first and second recurrence in a large cohort of patients after pancreatic resection for adenocarcinoma arising from IPMN. Summary Background Data: Recurrence patterns and treatment of recurrence post resection of adenocarcinoma arising from IPMN are poorly explored. Method: Patients undergoing pancreatic resection for adenocarcinoma from IPMN between January 2010 to December 2020 at 18 pancreatic centres were identified. Survival analysis was performed by the Kaplan-Meier log rank test and multivariable logistic regression by Cox-Proportional Hazards modelling. Endpoints were recurrence (time-to, location, and pattern of recurrence) and survival (overall survival and adjusted for treatment provided). Results: Four hundred and fifty-nine patients were included (median, 70 y; IQR, 64-76; male, 54 percent) with a median follow-up of 26.3 months (IQR, 13.0-48.1 mo). Recurrence occurred in 209 patients (45.5 percent; median time to recurrence, 32.8 months, early recurrence [within 1 y], 23.2 percent). Eighty-three (18.1 percent) patients experienced a local regional recurrence and 164 (35.7 percent) patients experienced distant recurrence. Adjuvant chemotherapy was not associated with reduction in recurrence (HR 1.09;P=0.669) One hundred and twenty patients with recurrence received further treatment. The median survival with and without additional treatment was 27.0 and 14.6 months (P<0.001), with no significant difference between treatment modalities. There was no significant difference in survival between location of recurrence (P=0.401). Conclusion: Recurrence after pancreatic resection for adenocarcinoma arising from IPMN is frequent with a quarter of patients recurring within 12 months. Treatment of recurrence is associated with improved overall survival and should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment

Lucocq,

Hawkyard,

Robertson

et al. 2023

Annals of Surgery

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“…In another retrospective study on 103 patients collected from 1993 to 2018, Rodrigues et al examined the impact of adjuvant chemotherapy and found that it could not provide survival benefits in node-negative patients but even compromise the prognosis (24). However, a systematic review of 11 studies and 3,393 invasive IPMNs found that node-positive patients could benefit from adjuvant chemotherapy (25). In order to determine the potential role of chemotherapy in the invasive IPMN cohort, we assessed the outcomes between patients who underwent surgery alone and those who received surgery plus chemotherapy after adjusting for confounding by the PSM method.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinicopathologic characteristics and survival outcomes between invasive IPMN and invasive MCN: A population-based analysis

Yang

Shi²

2022

Front. Oncol.

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BackgroundIntraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) are two main histological subtypes of pancreatic cystic neoplasms with rapidly increasing incidence recently. The natural histories, treatment patterns, and survival outcomes of invasive IPMN and invasive MCN have not been well explored.MethodsPatients with a diagnosis of invasive IPMN and invasive MCN in the SEER database from 2000 through 2018 were retrospectively identified. Multivariable Cox regression analysis was conducted to determine the independent risk factors associated with overall survival (OS). Subgroup analyses of survival outcomes for invasive IPMN and invasive MCN were conducted. The OS for invasive IPMN was compared between patients who underwent surgery alone and those who received surgery plus chemotherapy by propensity score matching (PSM).ResultsA total of 2,505 patients were included, of whom 2,300 were diagnosed with invasive IPMN and 205 were diagnosed with invasive MCN. Half of the invasive IPMN (48.4%) and three-quarters of the invasive MCN (76.1%) patients were female. Of all patients, both the OS and cancer-specific survival were significantly better in the invasive MCN cohort compared to the invasive IPMN cohort. In subgroup analyses, while invasive MCN experienced better OS compared to invasive IPMN in the subgroups of patients with local–regional disease, the survival advantages disappeared in patients at a distant stage. In addition, surgery plus chemotherapy in invasive IPMN patients was associated with significantly better survival compared to surgery alone after PSM.ConclusionWe examined the demographic and clinical characteristics between invasive IPMN and invasive MCN patients using a large-population-based analysis. Although the OS is significantly better for invasive MCN versus invasive IPMN, the difference disappeared in patients with distant disease. A combination of surgery and chemotherapy in selected invasive IPMN patients could confer survival benefits compared to surgery alone.

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“…A meta-analysis aimed to compare survival outcomes of invasive intraductal papillary mucinous neoplasms (IPMNs) treated with adjuvant chemotherapy versus surgery alone [11 ▪ ]. Eleven studies and 3393 patients were included.…”

Section: Adjuvant Therapy New Data and Effectiveness In Specific Subg...mentioning

confidence: 99%

Adjuvant and neoadjuvant approaches in pancreatic cancer

Conroy

Lambert

Ducreux

2023

Current Opinion in Oncology

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Purpose of reviewPancreatic cancer treatment remains a challenging problem for surgeons and oncologists. This review aims to summarize the current advances on adjuvant and neoadjuvant treatment approaches for resectable pancreatic cancer. Recent findingsRecent phase III randomized trials of adjuvant therapy showed improvement of overall survival in both experimental and control groups. Effectiveness of adjuvant therapy in specific subgroups as elderly patients, intraductal papillary mucinous neoplasms, stage I, and DNA damage repair gene germline variants has been reported. Completion of all cycles of planned adjuvant chemotherapy is confirmed as an independent prognostic factor. Adjuvant chemotherapy remains underutilized, mainly because of early recurrence, prolonged recovery, or older age older than 75 years. So, neoadjuvant treatment is a logical approach to administer systemic treatment to more patients. Meta-analysis did not demonstrate an overall survival benefit of neoadjuvant treatments in resectable pancreatic cancer, and definitive conclusions cannot be drawn from available randomized controlled trials. Upfront surgery and adjuvant chemotherapy should still be considered a standard approach in resectable pancreatic cancer.

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Adjuvant Chemotherapy in the Treatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas: Systematic Review and Meta‐Analysis

Cited by 10 publications

References 51 publications

Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment

Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment

Comparison of clinicopathologic characteristics and survival outcomes between invasive IPMN and invasive MCN: A population-based analysis

Adjuvant and neoadjuvant approaches in pancreatic cancer

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