CT in the prediction of margin-negative resection in pancreatic cancer following neoadjuvant treatment: a systematic review and meta-analysis

Park, Sohee; Jang, Jong Keon; Byun, Jae Ho; Kim, Jin Hee; Lee, Seung Soo; Kim, Hyoung Jung; Hong, Seung Baek

doi:10.1007/s00330-020-07433-0

Cited by 19 publications

(15 citation statements)

References 35 publications

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“…The current standard of care for POR in PDA is to ascertain resectability through imaging (computerized tomography or CT scans) [ 92 ]. Unfortunately, imaging provides limited information and can lead to misdiagnosis of 20% of unresectable PDAs and 36% of locally advanced or metastatic tumors as R-PDAs [ 93 , 94 ]. In resected tumors, the recurrence rate is very high (69–90%), and long-term survival (>10 years) is merely 4% (outcomes of key AT studies are summarized in Supplementary Table S3 ) [ 5 , 95 , 96 , 97 , 98 , 99 , 100 ].…”

Section: Cfdna For Pormentioning

confidence: 99%

Is Cell-Free DNA Testing in Pancreatic Ductal Adenocarcinoma Ready for Prime Time?

Sheel

Addison

Nuguru

et al. 2022

Cancers

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Cell-free DNA (cfDNA) testing currently does not have a significant role in PDA management: it is insufficient to diagnose PDA, and its use is primarily restricted to identifying targetable mutations (if tissue is insufficient or unavailable). cfDNA testing has the potential to address critical needs in PDA management, such as pre-operative risk stratification (POR), prognostication, and predicting (and monitoring) treatment response. Prior studies have focused primarily on somatic mutations, specifically KRAS variants, and have shown limited success in addressing prognosis and POR. Recent studies have demonstrated the importance of other less prevalent mutations (ERBB2 and TP53), but no studies have provided reliable mutation panels for clinical use. Methylation aberrations in cfDNA (epigenetic markers) in PDA have been relatively less explored. However, early evidence has suggested they offer diagnostic and, to some extent, prognostic value. The inclusion of epigenetic markers of cfDNA adds another dimension to genomic testing and may open new therapeutic avenues beyond addressing critical areas of need in PDA treatment. For cfDNA to substantially influence PDA management, concerted efforts are required to include less frequent mutations and epigenetic markers. Furthermore, relying on KRAS mutations for PDA management will always be inadequate.

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Section: Cfdna For Pormentioning

confidence: 99%

Is Cell-Free DNA Testing in Pancreatic Ductal Adenocarcinoma Ready for Prime Time?

Sheel

Addison

Nuguru

et al. 2022

Cancers

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“…Disease is usually split between resectable and borderline resectable/unresectable cases. With conventional imaging (CT), the distinction between these two categories is associated with a high sensitivity but reduced specificity (high false-positive rates) [62]. Staging laparoscopy is another way to confirm the operability of a PDAC defined as resectable on imaging.…”

Section: Prognostic Biomarkers and Predictors Of Resectabilitymentioning

confidence: 99%

Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome?

Khakoo

Petrillo

Salati

et al. 2021

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) has an aggressive tumor biology and is associated with poor survival outcomes. Most patients present with metastatic or locally advanced disease. In the 10–20% of patients with upfront resectable disease, surgery offers the only chance of cure, with the addition of adjuvant chemotherapy representing an established standard of care for improving outcomes. Despite resection followed by adjuvant chemotherapy, at best, 3-year survival reaches 63.4%. Post-operative complications and poor performance mean that around 50% of the patients do not commence adjuvant chemotherapy, and a significant proportion do not complete the intended treatment course. These factors, along with the advantages of early treatment of micrometastatic disease, the ability to downstage tumors, and the increase in R0 resection rates, have increased interest in neo-adjuvant treatment strategies. Here we review biomarkers for early diagnosis of PDAC and patient selection for a neo-adjuvant approach. We also review the current evidence for different chemotherapy regimens in this setting, as well as the role of chemoradiotherapy and immunotherapy, and we discuss ongoing trials.

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“…[6][7][8] In a recent meta-analysis, CT showed 45% summary sensitivity and 85% summary specificity for predicting R0 resection of PDAC following NAT. 9 Given this drawback, evidence from observational studies recommends considering resection of PDAC unless metastasis is apparent. 8,10,11 Recently, the National Comprehensive Cancer Network (NCCN) guidelines introduced tailored criteria for resection of PDAC following NAT, with these guidelines including both resectability on CT and clinical indices, such as carbohydrate antigen (CA) 19-9.…”

Section: Introductionmentioning

confidence: 99%

Prediction of margin‐negative resection of pancreatic ductal adenocarcinoma following neoadjuvant therapy: Diagnostic performance of NCCN criteria for resection vs CT‐determined resectability

Jang

Choi

Byun

et al. 2022

J Hepato Biliary Pancreat

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Background: Accurate assessment of pancreatic ductal adenocarcinoma (PDAC) resectability after neoadjuvant therapy (NAT) is crucial. Recently, the NCCN introduced criteria for resection of PDAC following NAT. Methods:We analyzed 127 patients who underwent NAT and pancreatectomy for PDAC between January 2010 and March 2020. CT-determined resectability according to the NCCN guideline and CA 19-9 level was evaluated before and after NAT. Diagnostic performance of the NCCN criteria for margin-negative (R0) resection was investigated and compared with CT alone.Results: R0 resection was achieved in 104 (81.9%) patients. After NAT, there were 30 (23.6%) resectable, 90 (70.9%) borderline resectable, and seven (5.5%) locally advanced tumors. Significantly decreased or stable CA 19-9 levels were noted in 114 (89.8%) patients. The sensitivity and specificity of the NCCN criteria were 87.5% (91/104) and 21.7% (5/23), respectively, which were significantly different from CT including only resectable PDAC (26.9% [28/104] and 91.3% [21/23]; P < .001), but less prominently different from CT including resectable and borderline resectable PDAC (95.2% [99/104]; P = .022 and 8.7% [2/23]; P = .375). Conclusions:The NCCN criteria for resection following NAT showed high sensitivity and low specificity for predicting R0 resection. It had supplementary benefit over CT alone, mainly in preventing underestimation of R0 resection. K E Y W O R D SCA-19-9 antigen, carcinoma, pancreatic ductal, computed tomography, margin of excision, neoadjuvant therapy This retrospective study was approved by our Institutional Review Board (IRB No. 2020-0251), which waived the need for informed patient consent.

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CT in the prediction of margin-negative resection in pancreatic cancer following neoadjuvant treatment: a systematic review and meta-analysis

Cited by 19 publications

References 35 publications

Is Cell-Free DNA Testing in Pancreatic Ductal Adenocarcinoma Ready for Prime Time?

Is Cell-Free DNA Testing in Pancreatic Ductal Adenocarcinoma Ready for Prime Time?

Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome?

Prediction of margin‐negative resection of pancreatic ductal adenocarcinoma following neoadjuvant therapy: Diagnostic performance of NCCN criteria for resection vs CT‐determined resectability

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