Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis
Background: Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-07-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/9/7/2132 |
| _version_ | 1797563158642032640 |
|---|---|
| author | Bathiya Ratnayake Alina Y. Savastyuk Manu Nayar Colin H. Wilson John A. Windsor Keith Roberts Jeremy J. French Sanjay Pandanaboyana |
| author_facet | Bathiya Ratnayake Alina Y. Savastyuk Manu Nayar Colin H. Wilson John A. Windsor Keith Roberts Jeremy J. French Sanjay Pandanaboyana |
| author_sort | Bathiya Ratnayake |
| collection | DOAJ |
| description | Background: Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review seeks to compare sites and patterns of recurrence after resection between patients undergoing upfront surgery (US) or after NAT. Methods: The EMBASE, SCOPUS, PubMed, and Cochrane library databases were systematically searched to identify eligible studies that compare recurrence patterns between patients who had NAT (followed by resection) with those that had US. The primary outcome included site-specific recurrence. Results: 26 articles were identified including 4986 patients who underwent resection. Borderline resectable pancreatic cancer (BRPC, 47% 1074/2264) was the most common, followed by resectable pancreatic cancer (RPC 42%, 949/2264). The weighted overall recurrence rates were lower among the NAT group, 63.4% vs. 74% (US) (OR 0.67 (CI 0.52–0.87), <i>p</i> = 0.006). The overall weighted locoregional recurrence rate was lower amongst patients who received NAT when compared to US (12% vs. 27% OR 0.39 (CI 0.22–0.70), <i>p</i> = 0.004). In BRPC, locoregional recurrence rates improved with NAT (NAT 25.8% US 37.7% OR 0.62 (CI 0.44–0.87), <i>p</i> = 0.007). NAT was associated with a lower weighted liver recurrence rate (NAT 19.4% US 30.1% OR 0.55 (CI 0.34–0.89), <i>p</i> = 0.023). Lung and peritoneal recurrence rates did not differ between NAT and US cohorts (<i>p</i> = 0.705 and <i>p</i> = 0.549 respectively). NAT was associated with a significantly longer weighted mean time to first recurrence 18.8 months compared to US (15.7 months) (OR 0.18 (CI 0.05–0.32), <i>p</i> = 0.015). Conclusion: NAT was associated with lower overall recurrence rate and improved locoregional disease control particularly for those with BRPC. Although the burden of liver metastases was less, there was no overall effect upon distant metastatic disease. |
| first_indexed | 2024-03-10T18:38:39Z |
| format | Article |
| id | doaj.art-8c6053d4b7cb4f809046e1822f767dfc |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T18:38:39Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8c6053d4b7cb4f809046e1822f767dfc2023-11-20T06:00:14ZengMDPI AGJournal of Clinical Medicine2077-03832020-07-0197213210.3390/jcm9072132Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-AnalysisBathiya Ratnayake0Alina Y. Savastyuk1Manu Nayar2Colin H. Wilson3John A. Windsor4Keith Roberts5Jeremy J. French6Sanjay Pandanaboyana7Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New ZealandDepartment of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New ZealandDepartment of Gastroenterology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, Tyne and Wear, UKDepartment of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, Tyne and Wear, UKDepartment of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New ZealandDepartment of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UKDepartment of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, Tyne and Wear, UKDepartment of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, Tyne and Wear, UKBackground: Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review seeks to compare sites and patterns of recurrence after resection between patients undergoing upfront surgery (US) or after NAT. Methods: The EMBASE, SCOPUS, PubMed, and Cochrane library databases were systematically searched to identify eligible studies that compare recurrence patterns between patients who had NAT (followed by resection) with those that had US. The primary outcome included site-specific recurrence. Results: 26 articles were identified including 4986 patients who underwent resection. Borderline resectable pancreatic cancer (BRPC, 47% 1074/2264) was the most common, followed by resectable pancreatic cancer (RPC 42%, 949/2264). The weighted overall recurrence rates were lower among the NAT group, 63.4% vs. 74% (US) (OR 0.67 (CI 0.52–0.87), <i>p</i> = 0.006). The overall weighted locoregional recurrence rate was lower amongst patients who received NAT when compared to US (12% vs. 27% OR 0.39 (CI 0.22–0.70), <i>p</i> = 0.004). In BRPC, locoregional recurrence rates improved with NAT (NAT 25.8% US 37.7% OR 0.62 (CI 0.44–0.87), <i>p</i> = 0.007). NAT was associated with a lower weighted liver recurrence rate (NAT 19.4% US 30.1% OR 0.55 (CI 0.34–0.89), <i>p</i> = 0.023). Lung and peritoneal recurrence rates did not differ between NAT and US cohorts (<i>p</i> = 0.705 and <i>p</i> = 0.549 respectively). NAT was associated with a significantly longer weighted mean time to first recurrence 18.8 months compared to US (15.7 months) (OR 0.18 (CI 0.05–0.32), <i>p</i> = 0.015). Conclusion: NAT was associated with lower overall recurrence rate and improved locoregional disease control particularly for those with BRPC. Although the burden of liver metastases was less, there was no overall effect upon distant metastatic disease.https://www.mdpi.com/2077-0383/9/7/2132recurrenceneoadjuvant chemotherapypancreatic ductal adenocarcinomapancreatic surgery |
| spellingShingle | Bathiya Ratnayake Alina Y. Savastyuk Manu Nayar Colin H. Wilson John A. Windsor Keith Roberts Jeremy J. French Sanjay Pandanaboyana Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis Journal of Clinical Medicine recurrence neoadjuvant chemotherapy pancreatic ductal adenocarcinoma pancreatic surgery |
| title | Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis |
| title_full | Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis |
| title_fullStr | Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis |
| title_full_unstemmed | Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis |
| title_short | Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis |
| title_sort | recurrence patterns for pancreatic ductal adenocarcinoma after upfront resection versus resection following neoadjuvant therapy a comprehensive meta analysis |
| topic | recurrence neoadjuvant chemotherapy pancreatic ductal adenocarcinoma pancreatic surgery |
| url | https://www.mdpi.com/2077-0383/9/7/2132 |
| work_keys_str_mv | AT bathiyaratnayake recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis AT alinaysavastyuk recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis AT manunayar recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis AT colinhwilson recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis AT johnawindsor recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis AT keithroberts recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis AT jeremyjfrench recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis AT sanjaypandanaboyana recurrencepatternsforpancreaticductaladenocarcinomaafterupfrontresectionversusresectionfollowingneoadjuvanttherapyacomprehensivemetaanalysis |