The impact of metastatic sites in advanced pancreatic adenocarcinoma, systematic review and meta-analysis of prospective randomized studies.

Autor: Usón PLS Junior; Hospital Israelita Albert Einstein, Oncology Department, São Paulo, Brazil.; Mayo Clinic, Phoenix, Arizona, United States., Tolentino FDS; Hospital Israelita Albert Einstein, Oncology Department, São Paulo, Brazil., Santos VM; Hospital Israelita Albert Einstein, Oncology Department, São Paulo, Brazil., Rother ET; Hospital Israelita Albert Einstein, Oncology Department, São Paulo, Brazil., Maluf FC; Hospital Israelita Albert Einstein, Oncology Department, São Paulo, Brazil.; Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Mar 04; Vol. 15 (3), pp. e0230060. Date of Electronic Publication: 2020 Mar 04 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0230060
Abstrakt: The real impact of specific sites of metastasis on prognosis of metastatic pancreatic cancer (MPC) is unknown. To evaluate the association of specific metastatic sites and survival outcomes in MPC a systematic literature review was performed including prospective randomized trials of systemic treatments in metastatic pancreatic cancer indexed in PubMed, Embase and Web of Science. Data regarding systemic treatment regimens, progression free survival and overall survival were extracted. The outcomes were compared using a random effects model. The index I2 and the graphs of funnel plot were used for the interpretation of the data. Of 1,052 abstracts, 7 randomized trials were considered eligible with a combined sample size of 2,975 MPC patients. Combining the studies with meta-analysis, we could see that patients with liver metastasis had a HR for death of 1.53 with 95% CI of 1.15 to 2.02 (p-value 0.003) and HR for risk of progression of 1.96 with 95% CI of 1.28 to 2.99 (p-value 0.002), without significant heterogeneity. Having two or more sites of metastasis comparing to one site did not have impact on overall survival; RR of 1.05 with 95% CI 0.91 to 1.23 (p-value 0.493). In conclusion, liver metastasis confers worse outcomes among patients with MPC. Apparently, multiple metastatic sites do not present worse prognosis when compared with only one organ involved, therefore, demonstrating the severity of this disease. Prospective studies evaluating other treatments are necessary to address the impact of local treatments in liver metastasis in MPC.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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