Upfront resection versus neoadjuvant therapy for T1/T2 pancreatic cancer

Vidrí, Roberto J.; Olsen, William T.; Clark, David E.; Fitzgerald, Timothy L.

doi:10.1016/j.hpb.2020.06.010

Cited by 6 publications

(11 citation statements)

References 28 publications

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“…Of these, 23 were excluded (14 did not meet the inclusion criteria, 7 were found to be protocols of unpublished data, and 2 were updated in included studies). Finally, 15 studies from databases were included in this work [ 17 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. In the study by Birrier et al, we considered only the results from their RCT, excluding those from Casadei et al and Golcher et al, whereas the results from Casadei et al and Golcher et al were retrieved from the original publication [ 27 , 28 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies were retrospective studies, six were RCTs, and in two, the study design was not reported. Five studies were conducted in the USA [ 30 , 31 , 33 , 36 , 37 ], two in Italy [ 27 , 32 ], Japan [ 28 , 35 ] and Germany [ 29 , 34 ] respectively, and one each in France [ 25 ], Switzerland [ 26 ], the Netherlands [ 18 ] and Korea [ 38 ]. The longest study—a retrospective study—examined an observation period of 32 years from 1989 to 2021 [ 37 ], while the shortest—one RCT—had a follow-up of 4 years from 2015 to 2019 [ 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies were conducted in the USA [ 30 , 31 , 33 , 36 , 37 ], two in Italy [ 27 , 32 ], Japan [ 28 , 35 ] and Germany [ 29 , 34 ] respectively, and one each in France [ 25 ], Switzerland [ 26 ], the Netherlands [ 18 ] and Korea [ 38 ]. The longest study—a retrospective study—examined an observation period of 32 years from 1989 to 2021 [ 37 ], while the shortest—one RCT—had a follow-up of 4 years from 2015 to 2019 [ 34 ]. Seven studies had a total sample size of more than 150 patients, with two studies including 6802 [ 37 ] and 8020 [ 30 ] patients, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The longest study—a retrospective study—examined an observation period of 32 years from 1989 to 2021 [ 37 ], while the shortest—one RCT—had a follow-up of 4 years from 2015 to 2019 [ 34 ]. Seven studies had a total sample size of more than 150 patients, with two studies including 6802 [ 37 ] and 8020 [ 30 ] patients, respectively. The median OS for NAT ranged from 15 months [ 25 ] to 50.2 months [ 35 ], while for the US it ranged from 14.3 months [ 18 ] to 32.7 months [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

“… Overall Survival: ( A ) Forest Plot [ 18 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]; ( B ) Overall Survival without outliers [ 18 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] (n = 13) (outlier: Barbier et al 2011 [ 25 ], Mokdad et al 2017 [ 30 ]). …”

Section: Figurementioning

confidence: 99%

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Neo-Adjuvant Treatment in Primary Resectable Pancreatic Cancer: A Systematic Review and PRISMA-Compliant Updated Metanalysis of Oncological Outcomes

Roesel,

Deantonio,

Bernardi

et al. 2023

Cancers

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Background: Despite advances in treatment, the prognosis of resectable pancreatic adenocarcinoma remains poor. Neoadjuvant therapy (NAT) has gained great interest in hopes of improving survival. However, the results of available studies based on different treatment approaches, such as chemotherapy and chemoradiotherapy, showed contrasting results. The aim of this systematic review and meta-analysis is to clarify the benefit of NAT compared to upfront surgery (US) in primarily resectable pancreatic adenocarcinoma. Methods: A PRISMA literature review identified 139 studies, of which 15 were finally included in the systematic review and meta-analysis. All data from eligible articles was summarized in a systematic summary and then used for the meta-analysis. Specifically, we used HR for OS and DFS and risk estimates (odds ratios) for the R0 resection rate and the N+ rate. The risk of bias was correctly assessed according to the nature of the studies included. Results: From the pooled HRs, OS for NAT patients was better, with an HR for death of 0.80 (95% CI: 0.72–0.90) at a significance level of less than 1%. In the sub-group analysis, no difference was found between patients treated with chemoradiotherapy or chemotherapy exclusively. The meta-analysis of seven studies that reported DFS for NAT resulted in a pooled HR for progression of 0.66 (95% CI: 0.56–0.79) with a significance level of less than 1%. A significantly lower risk of positive lymph nodes (OR: 0.45; 95% CI: 0.32–0.63) and an improved R0 resection rate (OR: 1.70; 95% CI: 1.23–2.36) were also found in patients treated with NAT, despite high heterogeneity. Conclusions: NAT is associated with improved survival for patients with resectable pancreatic adenocarcinoma; however, the optimal treatment strategy has yet to be defined, and further studies are required.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 3 more Smart Citations

Neo-Adjuvant Treatment in Primary Resectable Pancreatic Cancer: A Systematic Review and PRISMA-Compliant Updated Metanalysis of Oncological Outcomes

Roesel,

Deantonio,

Bernardi

et al. 2023

Cancers

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Comparison of the upfront surgery and neoadjuvant therapy in resectable and borderline resectable pancreatic cancer: an updated systematic review and meta-analysis

Yang,

Zou,

Dai

et al. 2023

Updates Surg

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2024

Int J Cancer Clin Res

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Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive and challenging cancers, causing substantial mortality worldwide. Despite advancements in treatment modalities, the prognosis for patients with PDAC remains dismal, emphasizing the critical need for identifying factors influencing early recurrence and survival post-surgery. This study aimed to clarify the risk factors for early recurrence (within 1 year) in patients who underwent upfront surgery for resectable PDAC. Methods:We retrospectively enrolled 127 patients who underwent upfront R0/R1 resection for resectable PDAC at our institute between January 2005 and December 2019. We collected clinicopathological background data and performed univariate and multivariate analyses to evaluate the risk factors for early recurrence. Results:The median follow-up period was 27 months. The overall and recurrence-free survival rates at 1, 3, and 5 years were 82%, 56%, and 33% and 68%, 33%, and 24%, respectively. Multivariate analysis revealed that CA19-9 ≥ 50U/mL and positive anterior peripancreatic surface invasion (T3) were independent risk factors. A prognostic staging model using one point for each risk factor provided a well-categorized predictive model. When all patients were classified into three groups (Score 0: neither CA19-9 ≥ 50 nor T3 factors; Score 1: one factor; and Score 2: both factors), the 5-year overall survival rates were 45%, 41%, and 22% for scores of 0, 1, and 2, respectively (p < 0.001). The corresponding 5-year recurrence-free survival rates were 45%, 30%, and 9%, respectively (p < 0.001). Conclusion:High preoperative CA19-9 level and peripancreatic infiltration were independent risk factors for early recurrence after upfront surgery.

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Upfront resection versus neoadjuvant therapy for T1/T2 pancreatic cancer

Cited by 6 publications

References 28 publications

Neo-Adjuvant Treatment in Primary Resectable Pancreatic Cancer: A Systematic Review and PRISMA-Compliant Updated Metanalysis of Oncological Outcomes

Neo-Adjuvant Treatment in Primary Resectable Pancreatic Cancer: A Systematic Review and PRISMA-Compliant Updated Metanalysis of Oncological Outcomes

Comparison of the upfront surgery and neoadjuvant therapy in resectable and borderline resectable pancreatic cancer: an updated systematic review and meta-analysis

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