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Meta-Analysis
. 2005 Apr 25;92(8):1372-81.
doi: 10.1038/sj.bjc.6602513.

Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer

D D Stocken  1 , M W Büchler, C Dervenis, C Bassi, H Jeekel, J H G Klinkenbijl, K E Bakkevold, T Takada, H Amano, J P Neoptolemos; Pancreatic Cancer Meta-analysis Group
Affiliations
Meta-Analysis

Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer

D D Stocken et al. Br J Cancer. .

Abstract

The aim of this study was to investigate the worldwide evidence of the roles of adjuvant chemoradiation and adjuvant chemotherapy on survival in potentially curative resected pancreatic cancer. Five randomised controlled trials of adjuvant treatment in patients with histologically proven pancreatic ductal adenocarcinoma were identified, of which the four most recent trials provided individual patient data (875 patients). This meta-analysis includes previously unpublished follow-up data on 261 patients. The pooled estimate of the hazard ratio (HR) indicated a 25% significant reduction in the risk of death with chemotherapy (H = 0.75, 95% confidence interval (CI): 0.64, 0.90, P-values(stratified) (Pstrat) = 0.001) with median survival estimated at 19.0 (95% CI: 16.4, 21.1) months with chemotherapy and 13.5 (95% CI: 12.2, 15.8) without. The 2- and 5-year survival rates were estimated at 38 and 19%, respectively, with chemotherapy and 28 and 12% without. The pooled estimate of the HR indicated no significant difference in the risk of death with chemoradiation (HR = 1.09, 95% CI: 0.89, 1.32, Pstrat = 0.43) with median survivals estimated at 15.8 (95% CI: 13.9, 18.1) months with chemoradiation and 15.2 (95% CI: 13.1, 18.2) without. The 2- and 5-year survival rates were estimated at 30 and 12%, respectively, with chemoradiation and 34 and 17% without. Subgroup analyses estimated that chemoradiation was more effective and chemotherapy less effective in patients with positive resection margins. These results show that chemotherapy is effective adjuvant treatment in pancreatic cancer but not chemoradiation. Further studies with chemoradiation are warranted in patients with positive resection margins, as chemotherapy appeared relatively ineffective in this patient subgroup.

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Figures

Figure 1
Figure 1
Hazard ratio plot of the effect of chemoradiation in the EORTC, ESPAC1 and GITSG randomised trials (CRT=adjuvant chemoradiation; ▪=individual estimate of the hazard ratio; ⋄=pooled stratified estimate of the hazard ratio).
Figure 2
Figure 2
Kaplan–Meier survival estimates by adjuvant chemoradiation in the EORTC and ESPAC1 trials (CRT=adjuvant chemoradiation).
Figure 3
Figure 3
Hazard Ratio plot of the effect of chemotherapy in the Norwegian, ESPAC1 and Japanese trials (CT=adjuvant chemotherapy; ▪=individual estimate of the hazard ratio; ⋄=pooled stratified estimate of the hazard ratio).
Figure 4
Figure 4
Kaplan–Meier survival estimates by adjuvant chemotherapy in the Norwegian, ESPAC1 and Japanese trials (CT=adjuvant chemotherapy).
Figure 5
Figure 5
Hazard ratio plot of the effect of chemoradiation by prognostic subgroups in the EORTC and ESPAC1 trials (CRT=adjuvant chemoradiation; ▪=individual estimate of the hazard ratio; ⋄=pooled stratified estimate of the hazard ratio).
Figure 6
Figure 6
Hazard ratio plot of the effect of chemotherapy by prognostic subgroups in the Norwegian, ESPAC1 and Japanese trials (CT=adjuvant chemotherapy; ▪=individual estimate of the hazard ratio; ⋄=pooled stratified estimate of the hazard ratio).
See this image and copyright information in PMC

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