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Meta-Analysis
. 2017 Oct 10;15(1):183.
doi: 10.1186/s12957-017-1240-2.

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

Mashaal Dhir  1 , Gautam K Malhotra  2 , Davendra P S Sohal  3 , Nicholas A Hein  4 , Lynette M Smith  4 , Eileen M O'Reilly  5 , Nathan Bahary  6 , Chandrakanth Are  7   8
Affiliations
Meta-Analysis

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

Mashaal Dhir et al. World J Surg Oncol. .

Abstract

Background: Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed.

Methods: PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched.

Results: A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0-16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively.

Conclusions: The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.

Keywords: Neoadjuvant therapy; Outcomes; Pancreatic adenocarcinoma; Pancreatic cancer; Survival.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable as the current article is a review.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
PRISMA Study flow diagram depicting search strategy, screening, selection, and exclusion criteria
Fig. 2
Fig. 2
Summary of outcomes after neoadjuvant therapy among resectable, borderline resectable, and locally advanced unresectable patients with pancreatic adenocarcinoma
Fig. 3
Fig. 3
Forest plot depicting pooled estimates for overall grade ≥ 3 toxicities among studies utilizing NCI CTCAE criteria for toxicity assessment during neoadjuvant therapy
Fig. 4
Fig. 4
Forest plots depicting pooled estimates for partial response at the time of restaging during or after neoadjuvant therapy. Only studies utilizing NCCN or AHBPA/SSO/SSAT criteria were included in the forest plot
Fig. 5
Fig. 5
Forest plots depicting pooled estimates for stable disease at the time of restaging during or after neoadjuvant therapy. Only studies utilizing NCCN or AHBPA/SSO/SSAT criteria were included in the forest plot
Fig. 6
Fig. 6
Forest plots depicting pooled estimates for progressive disease at the time of restaging during or after neoadjuvant therapy. Only studies utilizing NCCN or AHBPA/SSO/SSAT criteria were included in the forest plot
Fig. 7
Fig. 7
Forest plot depicting pooled estimates for resection rates after neoadjuvant therapy. Only studies utilizing NCCN or AHBPA/SSO/SSAT criteria were included in the forest plot
See this image and copyright information in PMC

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