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SCI 발표논문

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Sci Rep. 2019;9(1):15662.

Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer according to intention-to-treat and per-protocol analysis: A systematic review and meta-analysis.

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제1저자 이윤석, 이종찬 · 교신저자 황진혁

PMID 31666626 PMC6821820 DOI 10.1038/s41598-019-52167-9 IF 4.9 혈액종양내과
소속 (3)
  1. Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea.
  2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. woltoong@snu.ac.kr.

Abstract

The effectiveness of neoadjuvant therapy (NAT) remains unclear in resectable pancreatic cancer (PC) as compared with upfront surgery (US). The aim of this study was to investigate the survival gain of NAT over US in resectable PC. PubMed and EMBASE were searched for studies comparing survival outcomes between NAT and US for resectable PC until June 2018. Overall survival (OS) was analyzed according to treatment strategy (NAT versus US) and analytic methods (intention-to-treat analysis (ITT) and per-protocol analysis (PP)). In 14 studies, 2,699 and 6,992 patients were treated with NAT and US, respectively. Although PP analysis showed the survival gain of NAT (HR 0.72, 95% CI 0.68-0.76), ITT analysis did not show the statistical significance (HR 0.96, 95% CI 0.82-1.12). However, NAT completed with subsequent surgery showed better survival over US completed with adjuvant therapy (HR 0.82, 95% CI 0.71-0.93). In conclusion, the supporting evidence for NAT in resectable PC was insufficient because the benefit was not demonstrated in ITT analysis. However, among the patients who completed both surgery and chemotherapy, NAT showed survival benefit over adjuvant therapy. Therefore, NAT could have a role of triaging the patients for surgery even in resectable PC.

Figures

Figure 1
Figure 1 Flow diagram for identification of selected studies in the meta-analysis.
Figure 2
Figure 2 Anticancer therapy strategies and chemotherapy regimens in NAT and US strategy, respectively in the studies of this meta-analysis.
Figure 3
Figure 3 Meta-analyses of 14 studies on overall survival of NAT versus US using random effects model. NAT strategy had a better OS compared with US strategy in resectable pancreatic cancer (HR 0.80, 95% CI 0.70–0.92, P = 0.002). although the heterogeneity between studies is identified (Chi2 = 21.02, P = 0.070, I2 = 38%).
Figure 4
Figure 4 Subgroup analysis based on the analytic method of survival data (ITT or PP analysis). The subgroup analysis with PP analysis showed the survival gain of NAT (HR 0.72, 95% CI 0.68–0.76, P < 0.001). However, the studies with ITT analysis did not show the survival gain of NAT (HR 0.96, 95% CI 0.82–1.12, P = 0.610).
Figure 5
Figure 5 (A) Subgroup analysis regarding the delivery sequence showed that the neoadjuvant delivery of anticancer therapy had survival benefit over the adjuvant delivery among the patients underwent surgical resection (HR 0.82, 95% CI 0.71–0.93, P = 0.003) and the heterogeneity between studies was not significant (Chi2 = 3.57, P = 0.310, I2 = 16%). (B) Sensitivity analysis after excluding the study of Mokdad et al. showed that the trend of survival benefit of NAT still maintained.

그림 출처: PubMed Central 공개 논문 (PMC6821820)

Conflict of interest statement

The authors declare no competing interests.

그 밖의 정보
출판 형태
Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review
저널
Scientific reports · eISSN 2045-2322
전자 출판
2019-10-30
MeSH
Humans · Intention to Treat Analysis* · Neoadjuvant Therapy* · Pancreatic Neoplasms / surgery / therapy
참고문헌
38편