Upfront surgery versus neoadjuvant therapy for resectable pancreatic cancer: systematic review and Bayesian network meta-analysis

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Abstract

Current treatment recommendations for resectable pancreatic cancer support upfront resection and adjuvant therapy. Randomized controlled trials offering comparison with the emerging neoadjuvant approach are lacking.

This review aims to compare both treatment strategies for resectable pancreatic cancer. PubMed, MEDLINE, Embase, Cochrane Database and Cochrane Databases were searched for studies comparing neoadjuvant and surgery-first with adjuvant therapy for resectable pancreatic cancer. A Bayesian network meta-analysis was conducted using the Markov chain Monte Carlo method. Cochrane Collaboration’s risk of bias, ROBINS-I and GRADE tools were used to assess quality and risk of bias of included trials.

9 studies compared neoadjuvant therapy and surgery-first with adjuvant therapy (n = 22,285). Aggregate rate (AR) of R0 resection for neoadjuvant therapy was 0.8008 (0.3636–0.9144) versus 0.7515 (0.2026–0.8611) odds ratio (O.R.) 1.27 (95% CI 0.60–1.96). 1-year survival AR for neoadjuvant therapy was 0.7969 (0.6061–0.9500) versus 0.7481 (0.4848–0.8500) O.R. 1.38 (95% CI 0.69–2.96). 2-year survival AR for neoadjuvant therapy was 0.5178 (0.3000–0.5970) versus 0.5131 (0.2727–0.5346) O.R. 1.26 (95% CI 0.94–1.74). 5-year AR survival for neoadjuvant therapy was 0.2069 (0.0323–0.3300) versus 0.1783 (0.0606–0.2300) O.R. 1.19 (95% CI 0.65–1.73).

In conclusion neoadjuvant therapy may offer benefit over surgery-first and adjuvant therapy. However, further randomized controlled trials are needed.
Original languageEnglish
Article number4354
Number of pages7
JournalScientific Reports
Volume9
Issue number1
DOIs
Publication statusPublished - 13 Mar 2019

Keywords

  • pancreatic cancer
  • neoadjuvant therapy
  • Bayesian network model
  • surgery

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  • Cost-effectiveness analysis of neoadjuvant v surgery-first for resectable pancreatic cancer

    Bradley, A., Van Der Meer, R. & McKay, C., 27 Mar 2019. 1 p.

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  • Making personalized predictions of poor outcome post resection of pancreatic ductal adenocarcinoma (PDAC): a prognostic bayesian network with pre- and post-operative application

    Bradley, A., Van der Meer, R., McKay, C. & Jamieson, N., 5 Jun 2019, In : Pancreatology. 19, S1, p. S122 1 p., P6-13.

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