Predictors for Long-Term Survival After Resection of Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis

Abstract

Background Improved systemic therapy has made long term (≥ 5 years) overall survival (LTS) after resection of pancreatic ductal adenocarcinoma (PDAC) increasingly common. However, a systematic review on predictors of LTS following resection of PDAC is lacking. Methods The PubMed, Embase, Scopus, and Cochrane CENTRAL databases were systematically searched from inception until March 2023. Studies reporting actual survival data (based on follow-up and not survival analysis estimates) on factors associated with LTS were included. Meta-analyses were conducted by using a random effects model, and study quality was gauged by using the Newcastle-Ottawa Scale (NOS). Results Twenty-five studies with 27,091 patients (LTS: 2,132, non-LTS: 24,959) who underwent surgical resection for PDAC were meta-analyzed. The median proportion of LTS patients was 18.32% (IQR 12.97–21.18%) based on 20 studies. Predictors for LTS included sex, body mass index (BMI), preoperative levels of CA19-9, CEA, and albumin, neutrophil-lymphocyte ratio, tumor grade, AJCC stage, lymphovascular and perineural invasion, pathologic T-stage, nodal disease, metastatic disease, margin status, adjuvant therapy, vascular resection, operative time, operative blood loss, and perioperative blood transfusion. Most articles received a “good” NOS assessment, indicating an acceptable risk of bias. Conclusions Our meta-analysis pools all true follow up data in the literature to quantify associations between prognostic factors and LTS after resection of PDAC. While there appears to be evidence of a complex interplay between risk, tumor biology, patient characteristics, and management related factors, no single parameter can predict LTS after the resection of PDAC.

ASO Author Reflections: The Role of Established Prognostic Factors in Long-Term Survival After Resection of Pancreatic Ductal Adenocarcinoma

“…The systematic review included 27,091 patients with resected PDAC, all from studies reporting true LTS (i.e., with complete follow-up). 4 The median rate of LTS was 18% (interquartile range 13-21%) across studies from North America, Europe, and Asia. Pooled associations between established clinicopathologic factors and LTS included lower grade of tumor differentiation [odds ratio (OR) 1.75], lower American Joint Commission on Cancer (AJCC) stage (OR 3.4), receipt of adjuvant chemotherapy (OR 1.75), and negative surgical margins (OR 2.4).…”