Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis
Neoadjuvant treatment (NAT) followed by surgery is the primary treatment for borderline resectable pancreatic cancer (BRPC). However, there is limited high-level evidence supporting the efficacy of NAT in BRPC. PubMed was searched to identify studies that compared the survival between BRPC patients...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-09-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/14/18/4360 |
| _version_ | 1797490333296099328 |
|---|---|
| author | Hye-Sol Jung Hyeong Seok Kim Jae Seung Kang Yoon Hyung Kang Hee Ju Sohn Yoonhyeong Byun Youngmin Han Won-Gun Yun Young Jae Cho Mirang Lee Wooil Kwon Jin-Young Jang |
| author_facet | Hye-Sol Jung Hyeong Seok Kim Jae Seung Kang Yoon Hyung Kang Hee Ju Sohn Yoonhyeong Byun Youngmin Han Won-Gun Yun Young Jae Cho Mirang Lee Wooil Kwon Jin-Young Jang |
| author_sort | Hye-Sol Jung |
| collection | DOAJ |
| description | Neoadjuvant treatment (NAT) followed by surgery is the primary treatment for borderline resectable pancreatic cancer (BRPC). However, there is limited high-level evidence supporting the efficacy of NAT in BRPC. PubMed was searched to identify studies that compared the survival between BRPC patients who underwent NAT and those who underwent upfront surgery (UFS). The overall survival (OS) was compared using intention-to-treat (ITT) analysis. A total of 1204 publications were identified, and 19 publications with 21 data sets (2906 patients; NAT, 1516; UFS, 1390) were analyzed. Two randomized controlled trials and two prospective studies were included. Thirteen studies performed an ITT analysis, while six presented the data of resected patients. The NAT group had significantly better OS than the UFS group in the ITT analyses (HR: 0.63, 95% CI = 0.53–0.76) and resected patients (HR: 0.68, 95% CI = 0.60–0.78). Neoadjuvant chemotherapy with gemcitabine or S-1 and FOLFIRINOX improved the survival outcomes. Among the resected patients, the R0 resection and node-negativity rates were significantly higher in the NAT group. NAT improved the OS, R0 resection rate, and node-negativity rate compared with UFS. Standardizing treatment regimens based on high-quality evidence is fundamental for developing an optimal protocol. |
| first_indexed | 2024-03-10T00:30:30Z |
| format | Article |
| id | doaj.art-6a71c8e40b8e4ae8b6f9d7dd676833f0 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:30:30Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-6a71c8e40b8e4ae8b6f9d7dd676833f02023-11-23T15:25:52ZengMDPI AGCancers2072-66942022-09-011418436010.3390/cancers14184360Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-AnalysisHye-Sol Jung0Hyeong Seok Kim1Jae Seung Kang2Yoon Hyung Kang3Hee Ju Sohn4Yoonhyeong Byun5Youngmin Han6Won-Gun Yun7Young Jae Cho8Mirang Lee9Wooil Kwon10Jin-Young Jang11Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery, Chung-Ang University Gwang-Myeong Hospital, Gwangmyeong 14353, KoreaDepartment of Surgery, Uijeongbu Eulji Medical Center, School of Medicine, Eulji University, Daejeon 34824, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaDepartment of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, KoreaNeoadjuvant treatment (NAT) followed by surgery is the primary treatment for borderline resectable pancreatic cancer (BRPC). However, there is limited high-level evidence supporting the efficacy of NAT in BRPC. PubMed was searched to identify studies that compared the survival between BRPC patients who underwent NAT and those who underwent upfront surgery (UFS). The overall survival (OS) was compared using intention-to-treat (ITT) analysis. A total of 1204 publications were identified, and 19 publications with 21 data sets (2906 patients; NAT, 1516; UFS, 1390) were analyzed. Two randomized controlled trials and two prospective studies were included. Thirteen studies performed an ITT analysis, while six presented the data of resected patients. The NAT group had significantly better OS than the UFS group in the ITT analyses (HR: 0.63, 95% CI = 0.53–0.76) and resected patients (HR: 0.68, 95% CI = 0.60–0.78). Neoadjuvant chemotherapy with gemcitabine or S-1 and FOLFIRINOX improved the survival outcomes. Among the resected patients, the R0 resection and node-negativity rates were significantly higher in the NAT group. NAT improved the OS, R0 resection rate, and node-negativity rate compared with UFS. Standardizing treatment regimens based on high-quality evidence is fundamental for developing an optimal protocol.https://www.mdpi.com/2072-6694/14/18/4360meta-analysispancreatic cancerborderline resectableneoadjuvantprognosis |
| spellingShingle | Hye-Sol Jung Hyeong Seok Kim Jae Seung Kang Yoon Hyung Kang Hee Ju Sohn Yoonhyeong Byun Youngmin Han Won-Gun Yun Young Jae Cho Mirang Lee Wooil Kwon Jin-Young Jang Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis Cancers meta-analysis pancreatic cancer borderline resectable neoadjuvant prognosis |
| title | Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis |
| title_full | Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis |
| title_fullStr | Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis |
| title_short | Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis |
| title_sort | oncologic benefits of neoadjuvant treatment versus upfront surgery in borderline resectable pancreatic cancer a systematic review and meta analysis |
| topic | meta-analysis pancreatic cancer borderline resectable neoadjuvant prognosis |
| url | https://www.mdpi.com/2072-6694/14/18/4360 |
| work_keys_str_mv | AT hyesoljung oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT hyeongseokkim oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT jaeseungkang oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT yoonhyungkang oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT heejusohn oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT yoonhyeongbyun oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT youngminhan oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT wongunyun oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT youngjaecho oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT miranglee oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT wooilkwon oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis AT jinyoungjang oncologicbenefitsofneoadjuvanttreatmentversusupfrontsurgeryinborderlineresectablepancreaticcancerasystematicreviewandmetaanalysis |