Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Hye Sol Jung, Hyeong Seok Kim, Jae Seung Kang, Yoon Hyung Kang, Hee Ju Sohn, Yoonhyeong Byun, Youngmin Han, Won Gun Yun, Young Jae Cho, Mirang Lee, Wooil Kwon, Jin Young Jang

Research output: Contribution to journalReview articlepeer-review

Abstract

Neoadjuvant treatment (NAT) followed by surgery is the primary treatment for borderline resectable pancreatic cancer (BRPC). However, there is limited high-level evidence supporting the efficacy of NAT in BRPC. PubMed was searched to identify studies that compared the survival between BRPC patients who underwent NAT and those who underwent upfront surgery (UFS). The overall survival (OS) was compared using intention-to-treat (ITT) analysis. A total of 1204 publications were identified, and 19 publications with 21 data sets (2906 patients; NAT, 1516; UFS, 1390) were analyzed. Two randomized controlled trials and two prospective studies were included. Thirteen studies performed an ITT analysis, while six presented the data of resected patients. The NAT group had significantly better OS than the UFS group in the ITT analyses (HR: 0.63, 95% CI = 0.53–0.76) and resected patients (HR: 0.68, 95% CI = 0.60–0.78). Neoadjuvant chemotherapy with gemcitabine or S-1 and FOLFIRINOX improved the survival outcomes. Among the resected patients, the R0 resection and node-negativity rates were significantly higher in the NAT group. NAT improved the OS, R0 resection rate, and node-negativity rate compared with UFS. Standardizing treatment regimens based on high-quality evidence is fundamental for developing an optimal protocol.

Original languageEnglish
Article number4360
JournalCancers
Volume14
Issue number18
DOIs
StatePublished - Sep 2022
Externally publishedYes

Keywords

  • borderline resectable
  • meta-analysis
  • neoadjuvant
  • pancreatic cancer
  • prognosis

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