Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients

Dhir, Mashaal; Malhotra, Gautam; Sohal, Davendra; Hein, Nicholas; Smith, Lynette M.; O'Reilly, Eileen Mary; Bahary, Nathan; Are, Chandrakanth

doi:10.1186/s12957-017-1240-2

Cited by 121 publications

(122 citation statements)

References 120 publications

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“…15,20 A recent systematic review and meta-analysis on patients with 935 BRPC reported the rate of exploration in these patients to be 77% and the rate of resectability to be 69%. 21 Katz et al in their initial report of the ALLIANCE trial A021101 reported the rate of resectability in BRPC to be 68% following neoadjuvant treatment (15/22). 22 Similar to our findings, the PREOPANC-1 trial reported a rate of resection of 72% in BRPC patients who underwent straight to surgery as compared to 62% in patients who received neoadjuvant therapy prior to resection.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

Javed

Wright

Siddique

et al. 2019

Journal of Gastrointestinal Surgery

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Introduction Approximately, 20% of patients with pancreatic ductal adenocarcinoma have resectable disease at diagnosis. Given improvements in locoregional and systemic therapies, some patients with borderline resectable pancreatic cancer (BRPC) can now undergo successful resection. The outcomes of patients with BRPC after neoadjuvant therapy remain unclear. Methods A prospectively maintained single-institution database was utilized to identify patients with BRPC who were managed at the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC) between 2013 and 2016. BRPC was defined as any tumor that presented with radiographic evidence of the involvement of the portal vein (PV) or superior mesenteric vein (SMV) that was deemed to be technically resectable (with or without the need for reconstruction), or the abutment (< 180° involvement) of the common hepatic artery (CHA) or superior mesenteric artery (SMA), in the absence of involvement of the celiac axis (CA). We collected data on treatment, the course of the disease, resection rate, and survival. Results Of the 866 patients evaluated at the PMDC during the study period, 151 (17.5%) were staged as BRPC. Ninety-six patients (63.6%) underwent resection. Neoadjuvant chemotherapy was administered to 142 patients (94.0%), while 78 patients (51.7%) received radiation therapy in the neoadjuvant setting. The median overall survival from the date of diagnosis, of resected BRPC patients, was 28.8 months compared to 14.5 months in those who did not (p < 0.001). Factors associated with increased chance of surgical resection included lower ECOG performance status (p = 0.011) and neck location of the tumor (p = 0.001). Forty-seven patients with BRPC (31.1%) demonstrated progression of disease; surgical resection was attempted and aborted in 12 patients (7.9%). Eight patients (5.3%) were unable to tolerate chemotherapy; six had disease progression and two did not want to pursue surgery. Lastly, four patients (3.3%) were conditionally unresectable due to medical comorbidities at the time of diagnosis due to comorbidities and failed to improve their status and subsequently had progression of the disease. Conclusion After initial management, 31.1% of patients with BRPC have progression of disease, while 63.6% of all patients successfully undergo resection, which was associated with improved survival. Factors associated with increased likelihood of surgical resection include lower ECOG performance status and tumor location in the neck.

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Section: Discussionmentioning

confidence: 99%

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

Javed

Wright

Siddique

et al. 2019

Journal of Gastrointestinal Surgery

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“…In addition to altering patient selection for surgery, high neoadjuvant utilization may contribute to improved outcomes [38]. Therefore, the recent literature on neoadjuvant therapy in PDAC demonstrates improved outcomes after neoadjuvant therapy compared to those historically associated with the surgery-first approach for PDAC reported in a systematic review and meta-analysis of 5,520 patients [39]. …”

Section: Discussionmentioning

confidence: 99%

Predictive Early Recurrence Factors of Preoperative Clinicophysiological Findings in Pancreatic Cancer

et al. 2018

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Background: We aimed to evaluate the use of preoperative clinicophysiological parameters as predictive risk factors for early recurrence of pancreatic ductal adenocarcinoma (PDAC) after curative resection. Methods: A total of 260 patients who underwent pancreatic resection for PDAC between 2007 and 2015 were examined retrospectively. We divided the patients into those with early recurrence (within 6 months; group A, n = 52) and those with relapse within ≥6 months or without recurrence (group B, n = 208). Data regarding clinicophysiological parameters were analyzed as predictors of disease-free survival (DFS). These factors were analyzed by χ² tests on univariate analysis and Cox proportional hazard models on multivariate analyses. Kaplan-Meier survival curves were generated using log-rank tests. Results: Groups A and B had significantly different preoperative carbohydrate antigen 19-9 (CA19-9) levels, carcinoembryonic antigen (CEA) levels, and curability. Univariate and multivariate analysis showed that CA19-9 and CEA were independent prognostic factors for early recurrence. Patients with CA19-9 levels > 124.65 U/mL had significantly shorter DFS than those with lower levels, as did patients with CEA levels > 4.45 ng/mL. Conclusions: Our results show that elevated CA19-9 (> 124.65 U/mL) and CEA (> 4.45 ng/mL) were independent predictors of early recurrence after pancreatic resection in PDAC patients.

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“…Furthermore, the rates of resection after neoadjuvant therapy were 76%, 69% and 26% for resectable PDAC, bordeline PDAC and locally advanced PDAC, respectively (70). The median overall survival time after neoadjuvant therapy and pancreatectomy was 30 months for resectable PDAC, 27.4 months for borderline PDAC and 18.7 months for locally advanced PDAC (70). It is worth to mention that a limited number of patients in the analyzed studies included FOLFIRINOX regimens (70).…”

Section: Neoadjuvant Therapies In Pdacmentioning

confidence: 98%

“…A recent systematic review and meta-analysis has shown that neoadjuvant therapy is associated with a radiological response (i.e., disease control) in 88% of the patients with resectable PDAC and in 77% of patients with borderline and locally advanced PDAC (70). Furthermore, the rates of resection after neoadjuvant therapy were 76%, 69% and 26% for resectable PDAC, bordeline PDAC and locally advanced PDAC, respectively (70).…”

Section: Neoadjuvant Therapies In Pdacmentioning

confidence: 99%

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Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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Pancreatic ductal adenocarcinoma (PDAC) is an important healthcare problem because is a leading cause of death by cancer. PDAC is a highly lethal disease with a very dismal prognosis. Most patients present advanced disease at diagnosis. The management of a patient diagnosed with PDAC should be discussed in a multidisciplinary team in high-volume centers. Pancreatectomy represents the single hope of long-term survival for a patient with PDAC but the resectability rate is less than 20% of the cases. Several progresses were observed in the last years regarding the surgical and oncological approach for PDAC. The aim of the paper is to make a brief review of the current onco-surgical strategies available for patients with PDAC.

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Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients

Cited by 121 publications

References 120 publications

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

Predictive Early Recurrence Factors of Preoperative Clinicophysiological Findings in Pancreatic Cancer

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

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