Systemic neoadjuvant chemotherapy in modern pancreatic cancer treatment: a systematic review and meta-analysis.

Autor:	Rangarajan K; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Pucher PH; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Department of Surgery, St Mary's Hospital, Imperial College London, Southampton, UK., Armstrong T; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Bateman A; Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Hamady Z; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Jazyk:	angličtina
Zdroj:	Annals of the Royal College of Surgeons of England [Ann R Coll Surg Engl] 2019 Sep; Vol. 101 (7), pp. 453-462. Date of Electronic Publication: 2019 Jul 15.
DOI:	10.1308/rcsann.2019.0060
Abstrakt:	Background: Pancreatic ductal adenocarcinoma remains a disease with a poor prognosis despite advances in surgery and systemic therapies. Neoadjuvant therapy strategies are a promising alternative to adjuvant chemotherapy. However, their role remains controversial. This meta-analysis aims to clarify the benefits of neoadjuvant therapy in resectable pancreatic ductal adenocarcinoma. Methods: Eligible studies were identified from MEDLINE, Embase, Web of Science and the Cochrane Library. Studies comparing neoadjuvant therapy with a surgery first approach (with or without adjuvant therapy) in resectable pancreatic ductal adenocarcinoma were included. The primary outcome assessed was overall survival. A random-effects meta-analysis was performed, together with pooling of unadjusted Kaplan-Meier curve data. Results: A total of 533 studies were identified that analysed the effect of neoadjuvant therapy in pancreatic ductal adenocarcinoma. Twenty-seven studies were included in the final data synthesis. Meta-analysis suggested beneficial effects of neoadjuvant therapy with prolonged survival compared with a surgery-first approach, (hazard ratio 0.72, 95% confidence interval 0.69-0.76). In addition, R0 resection rates were significantly higher in patients receiving neoadjuvant therapy (relative risk 0.51, 95% confidence interval 0.47-0.55). Individual patient data analysis suggested that overall survival was better for patients receiving neoadjuvant therapy ( P = 0.008). Conclusions: Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change.
Databáze:	MEDLINE
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