The impact of neoadjuvant therapy on the histopathological features of pancreatic ductal adenocarcinoma – A systematic review and meta-analysis

Schorn, Stefan; Demir, Ihsan Ekin; Reyes, Carmen Mota; Saricaoglu, Cemil; Samm, Nicole; Schirren, Rebekka; Tieftrunk, Elke; Frieß, Helmut; Ceyhan, Güralp O.

doi:10.1016/j.ctrv.2017.03.003

Cited by 86 publications

(57 citation statements)

References 66 publications

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“…The effect of neoadjuvant therapy on preoperative primary tumour classification as RPC or BRPC revealed, for both groups, that patients receiving this treatment had smaller tumours, better UICC stage and more tumour‐free lymph nodes than patients who had primary surgery29. In a recent meta‐analysis30, neoadjuvant therapy reduced not only tumour size, tumour‐positive lymph nodes and the rate of positive resection margins, but also the rate of dedifferentiated cancer and lymphatic vessel invasion.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

et al. 2018

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BackgroundNeoadjuvant therapy may increase the rate of radical tumour resection in patients with pancreatic cancer. Its impact on tumour recurrence has not been investigated fully. This study aimed to assess the impact of neoadjuvant therapy on patterns of recurrence.MethodsA systematic review was performed of articles identified through the PubMed, Scopus, Embase, Ovid and Google Scholar databases that analysed the relationship between neoadjuvant therapy and recurrence published to January 2016. The main endpoint was overall tumour recurrence. Other endpoints included local recurrence, any kind of distant, hepatic, pulmonary or peritoneal metastasis.ResultsA total of 4257 citations were reviewed. Twelve observational studies comprising 1365 patients were analysed. Neoadjuvant therapy significantly reduced the risk of overall (risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·90; P < 0·001) and local (RR 0·42, 0·32 to 0·55; P < 0·001) recurrence. Neoadjuvant therapy did not reduce the risk of any kind of distant (RR 1·02, 0·91 to 1·14; P = 0·78), hepatic (RR 0·86, 0·68 to 1·10; P = 0·23), pulmonary (RR 0·99, 0·37 to 2·66; P = 0·98) or peritoneal (RR 0·88, 0·57 to 1·38; P = 0·58) metastasis.ConclusionNeoadjuvant therapy reduced the risk of local recurrence but not that of distant metastasis.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

et al. 2018

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“…A small percentage of a complete pathologic response (2% to 7%) was also reported in meta-analyses [15,16]. Finally, patients with NAT are less likely to have positive lymph nodes and perineural invasion on histopathologic workup [17].…”

Section: Histopathologic Response Patterns Of Pdacmentioning

confidence: 70%

Imaging response evaluation after novel neoadjuvant treatments of pancreatic cancer

Gassner

Poskaite

2019

Eur Surg

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Background Emergent neoadjuvant concepts have improved the rate of margin-free (R0) resections in borderline resectable and locally advanced pancreatic ductal adenocarcinoma. However, due to specific properties of pancreatic cancer, imaging response assessment is difficult. Methods The concepts of histologic response patterns and their imaging correlates are outlined, together with efforts in morphologic and functional imaging to overcome the challenges of response assessment. Results Imaging evaluation after neoadjuvant therapy remains a diagnostic dilemma. To date, better understanding of the specific transformations of PDAC under neoadjuvant agents could not be transformed into validated imaging criteria for defining response and selecting surgical candidates. Conclusion Currently, patients with non-metastatic borderline resectable and locally advanced pancreatic ductal adenocarcinoma are brought to diagnostic laparotomy in the absence of overt radiologic progression after neoadjuvant therapy. Apart from morphologic patterns, ongoing research is focused on defining robust functional imaging parameters for response assessment.

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“…This result was consistent with previous results found for NAC treatment of BRPC and LAPC. 12,25,26 However, no statistical boundary, which assumes a 30% control event rate and a 60% relative risk reduction with 80% power and a two sided a = 0.05, has been crossed, indicating that the cumulative evidence is conclusive HPB 2020, 22, 821-832 difference in OS between the two groups was found. There might be many explanations for this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] Nevertheless, because of postoperative complications or delayed recovery from surgery, adjuvant chemotherapy is not administered in 20-30% of patients, which limits the effect of treatment. [10][11][12] The concept of neoadjuvant, rather than adjuvant, chemotherapy in pancreatic cancer might be a more attractive option. Compared with adjuvant chemotherapy, chemotherapeutic drugs can reach a higher concentration in the tumor microenvironment before surgery because tumor blood supply is not damaged at this time, leading to a stronger inhibitory effect on tumor cells.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemotherapy for primary resectable pancreatic cancer: a systematic review and meta-analysis

Ye¹,

Zhang²,

Chen³

et al. 2020

HPB

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Background: Preoperative chemotherapy has shown benefits for locally advanced and borderline resectable pancreatic cancer. Neoadjuvant chemotherapy (NAC) has also been attempted in resectable pancreatic cancer (RPC); however, its role remains controversial. This study aimed to compare the clinical difference between NAC and upfront resection (UR) in RPC.Methods: Electronic databases including PubMed, Embase, Medline, Web of Science, ClinicalTrials. gov, and Cochrane Central Register of Controlled Trials were searched for relevant articles from inception to February 2019 that addressed the overall survival in patients with RPC treated with or without NAC to identify eligible studies. Eleven studies were included in the final meta-analysis. The quality assessment of the included studies was based on the Newcastle-Ottawa quality scale. Data of the unresectable rate, R0 resection rate, and positive lymph node rate were also extracted in each study for further analysis. Pooled hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CIs) were calculated to assess the strength of the association.Results: A total of eleven studies (eight cohort studies and three randomized controlled trials) involving 9773 patients were included. Ten of the eleven studies followed the "intention-to-treat" principle. NAC was found to be significantly associated with a higher R0 resection rate (P < 0.0001; OR = 2.62, 95% CI 1.70-4.03) and increased negative lymph node rate (P < 0.00001; OR = 0.34, 95% CI 0.31-0.37).However, compared with the UR group, NAC was related to a lower surgical resection rate (P = 0.0004; OR = 2.18, 95% CI 1.41-3.37). Overall, the NAC group exhibited no benefits in terms of overall survival compared with that in the UR group (P = 0.10; HR = 0.86, 95% CI 0.73-1.03). In the subgroup analysis, however, patients who received gemcitabine-based regimen as the NAC strategy had more favorable overall survival than that in the UR group (P = 0.04; HR = 0.75, 95% CI 0.57-0.99).Conclusions: NAC may be associated with a lower resection rate; however, it is associated with an increased R0 resection rate and lymph node negative rate. Although overall survival was similar in patients with or without NAC, gemcitabine-based NAC might provide longer overall survival. Further largevolume, randomized controlled trials are needed to validate the improved prognosis of patients undergoing NAC.

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The impact of neoadjuvant therapy on the histopathological features of pancreatic ductal adenocarcinoma – A systematic review and meta-analysis

Cited by 86 publications

References 66 publications

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

Imaging response evaluation after novel neoadjuvant treatments of pancreatic cancer

Neoadjuvant chemotherapy for primary resectable pancreatic cancer: a systematic review and meta-analysis

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