Management of recurrent pancreatic cancer after surgical resection: a protocol for systematic review, evidence mapping and meta-analysis

Abstract

IntroductionAlthough recurrence rate among cases of resected pancreatic cancer are as high as 85%, an optimal treatment for recurrent pancreatic cancer (RePC) has not been established. Previous evidence regarding RePC is scarce, and randomised controlled trials (RCTs) are particularly lacking. The evidence mapping (EM) method has been introduced as a tool intended to complement the conventional systematic review (SR) and meta-analysis (MA) and is suitable for this issue. This review aims to investigate the optimal treatment options for RePC, using a newly developed automatic EM tool. Method and analysisAll study types, including RCTs, non-randomised studies and other forms of observational studies will be included in the SR-EM. The Medline, Embase, Cochrane library and Scopus databases will be searched for reports of five treatment options for local and metastatic recurrences, including re-resection, chemotherapy, radiotherapy, best supportive care and other novel treatments, published from database inception to 30 April 2017. References from relevant studies will be searched manually. If meta-analysis is feasible, the primary outcome measure will be median overall survival. Two independent authors will select the studies and assess the risk of bias, and a third author will resolve discrepancies in consensus meeting. To visualise EM, we will use a novel web-based and open-access mapping programme, Plotting E-Map (PLOEM) (http://plotting-e-map.com). If eligible combinations of interventions for quantitative comparison are identified, we will conduct subgroup MAs using random-effect models and I2 statistics. Publication bias will be visualised using funnel plots.Ethics and disseminationThis study will not use primary data, and therefore formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.PROSPEROregistration number CRD42016049178.

Circulating tumor DNA as a prognostic indicator in resectable pancreatic ductal adenocarcinoma: A systematic review and meta-analysis

“…Patients with early stage PDAC are usually recommended to undergo extensive surgery as well as adjunctive chemotherapy before and/or after surgery. Nevertheless, up to 85% of resectable PDAC results in recurrence 3 and therefore, the use of biomarkers to predict the prognosis and recurrence of PDAC is essential. Recently, ctDNA has been suggested as a promising prognostic biomarker in various cancers including PDAC.…”

“…Surgical resection remains the only chance for cure, increasing the five-year survival rate to 15–25% 2 . However, tumors recur in 85% of resected cases; therefore, identifying patients with a high risk of recurrence is a major challenge 3 . Hence, it is important to find out effective strategies for evaluating the risk of recurrence and mortality in resectable PDAC.…”

Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer

“…In metastatic pancreatic cancer patients, current studies have demonstrated that FOLFIRINOX, nab-paclitaxel plus gemcitabine, and nanoliposomal irinotecan increased the tumor responses and OS compared to the aforementioned conventional chemotherapy regimens [28,29,30,31,32,33]. In addition, several studies showed that aggressive treatment of an isolated local recurrence with re-resection, chemoradiotherapy, or stereotactic body radiation therapy provides survival benefit to these patients [55,56,57,58]. We believe that the use of a combination of H & P, tests for both tumor makers (CEA and CA19-9), and CT as surveillance can detect the local recurrence or metastases in resected pancreatic cancer patients early, and thus, allow aggressive local therapy and current systemic chemotherapy regimens, which will not only increase PROS (more than our PROS of 7.8 months in the intensive group) but also prolong OS.…”

Activation of Nrf2 by Sulforaphane Inhibits High Glucose-Induced Progression of Pancreatic Cancer via AMPK Dependent Signaling

“…Pancreatic cancer is a lethal tumor characterized by early metastasis and a high recurrence rate, with a dismal 5-year survival rate of less than 8% [1][2][3]. Unlike many other cancers, patients remain almost symptomless in the early stage of this disease.…”