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The benefits of neoadjuvant therapy for patients with resectable pancreatic cancer: an updated systematic review and meta-analysis

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Abstract

Neoadjuvant therapy (NAT) was effective in improving overall survival (OS) of borderline resectable pancreatic cancer. However, its application in resectable pancreatic cancer remains controversial. This study aimed to determine whether NAT has a greater advantage over conventional upfront surgery (US) in terms of resection rate, R0 resection rate, positive lymph node rate, and OS. We identified articles before October 7, 2022, by searching four electronic databases. The studies included in the meta-analysis all met the inclusion and exclusion criteria. The Newcastle–Ottawa scale was used to evaluate the quality of the articles. OS, DFS, resection rate, R0 resection rate and positive lymph nodes rate were extracted. Odds ratio (OR), hazard ratio (HR) and 95% confidence intervals (CI) were calculated, and sensitivity analysis and publication bias were used to assess the sources of heterogeneity. In total, 24 studies, involving 1384 (35.66%) patients assigned to NAT and 2497 (64.43%) patients assigned to US, were included in the analysis. NAT could effectively prolong OS (HR 0.73, 95% CI 0.65–0.82, P < 0.001) and DFS (HR 0.72, 95% CI 0.62–0.84, P < 0.001). Subgroup analysis results of 6 randomized controlled trials (RCTs) also showed that RPC patients could benefit from NAT in the long term (HR 0.72, 95% CI 0.58–0.90, P = 0.003). NAT decreased resection rate (OR 0.43, 95% CI 0.33–0.55, P < 0.001), but was associated with increased R0 resection rate (OR 2.05, 95% CI 1.47–2.88, P < 0.001) and decreased positive lymph node rate (OR 0.38, 95% CI 0.27–0.52, P < 0.001). Although the application of NAT increases the risk of patients not being able to undergo surgical resection, it can prolong the OS and delay tumor progression in RPC. Therefore, we still expect larger and higher-quality RCTs to confirm the effectiveness of NAT.

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Abbreviations

PC:

Pancreatic cancer

RPC:

Resectable pancreatic cancer

BRPC:

Borderline resectable pancreatic cancer

SMV/PV:

Superior mesenteric vein/portal vein

RCS:

Retrospective cohort study

RCT:

Randomized clinical trial

DFS:

Disease-free survival

OS:

Overall survival

mOS:

Median overall survival

mDFS:

Median disease-free survival

NAT:

Neoadjuvant therapy

US:

Upfront surgery

OR:

Odds ratio

HR:

Hazard ratio

CI:

Confidence interval

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The authors declare that no funds, grants or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of General Surgery, Peking University First Hospital, Beijing, 100034, China

    Bohan Yang, Kai Chen, Weikang Liu, Di Long, Yingjin Wang, Xinxin Liu, Yongsu Ma, Xiaodong Tian & Yinmo Yang

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Contributions

Conceptualization: YMY. Literature Search: BHY, KC. Methodology: BHY, KC. Data Extracted: BHY, WKL. Validation: BHY, KC, WKL, DL, YJW, XXL and YSM. Formal analysis and investigation: BHY, WKL. Writing—original draft: BHY. Writing—review and editing: XDT. Supervision: XDT, YMY. All authors read and approved the final manuscript.

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Correspondence to Xiaodong Tian or Yinmo Yang.

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The authors have no relevant financial or non-financial interests to disclose. The meta-analysis was not registered, and a review protocol was not prepared.

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Yang, B., Chen, K., Liu, W. et al. The benefits of neoadjuvant therapy for patients with resectable pancreatic cancer: an updated systematic review and meta-analysis. Clin Exp Med 23, 3159–3169 (2023). https://doi.org/10.1007/s10238-023-01112-2

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