Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials
Background: Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been establis...
| Autores: | , , , , , , , , , |
|---|---|
| Formato: | artículo |
| Fecha de publicación: | 2024 |
| País: | España |
| Recursos: | Universidad de Navarra |
| Repositorio: | Dadun. Depósito Académico Digital de la Universidad de Navarra |
| Idioma: | inglés |
| OAI Identifier: | oai:dadun.unav.edu:10171/70166 |
| Acesso em linha: | https://hdl.handle.net/10171/70166 |
| Access Level: | acceso abierto |
| Palavra-chave: | Neoadjuvant treatment Pancreatic ductal adenocarcinoma Bayesian meta-analysis |
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Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trialsAliseda-Jover, D. (Daniel)|||/items/bfa542c5-12cf-4850-959a-d81305d560cdMarti-Cruchaga, P. (Pablo)|||/items/97577c37-4c78-4a17-8b03-55eec0b40ff9Zozaya-Larequi, G.N. (Gabriel Nicolás)|||/items/edce37f2-5ec6-40e5-996d-57a6e3ca7b0eBlanco, N. (Nuria)|||/items/98d5610d-0d00-4344-a7e3-ca9e2566cea7Ponz-Sarvise, M. (Mariano)|||/items/2439c580-068e-431b-a20d-bdeab1b7c3adChopitea-Ortega, A. (Ana)|||/items/4234674f-5287-4a3a-a66e-8b82d25afe53Castañón-Álvarez, E. (Eduardo)|||/items/6ef1df2b-d729-4ca8-af2e-dd81758ddd7aPardo, F. (Fernando)|||/items/f4488eb3-3bf9-4dff-9d3f-402f36a1721eRotellar-Sastre, F. (Fernando)|||/items/833cb788-f4b9-404d-a18b-ae1c84369b51Rodríguez-Rodríguez, J. (Javier)|||/items/eb216e0c-3040-4db1-82a3-45514feafb00Neoadjuvant treatmentPancreatic ductal adenocarcinomaBayesian meta-analysisBackground: Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been established. The aim of this study was to compare long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma based on whether they received neoadjuvant treatment or underwent upfront surgery. Methods: A systematic review including randomized clinical trials on the overall survival outcomes between neoadjuvant treatment and upfront surgery in patients with resectable pancreatic ductal adenocarcinoma was conducted up to 1 August 2023 from PubMed, MEDLINE and Web of Science databases. Patient-level survival data was extracted and reconstructed from available Kaplan–Meier curves. A frequentist one-stage meta-analysis was employed, using Cox-based models and a non-parametric method (restricted mean survival time), to assess the difference in overall survival between groups. A Bayesian meta-analysis was also conducted. Results: Five randomized clinical trials comprising 625 patients were included. Among patients with resectable pancreatic ductal adenocarcinoma, neoadjuvant treatment was not significantly associated with a reduction in the hazard of death compared with upfront surgery (shared frailty HR 0.88, 95% c.i. 0.72 to 1.08, P = 0.223); this result was consistent in the non-parametric restricted mean survival time model (+2.41 months, 95% c.i. −1.22 to 6.04, P < 0.194), in the sensitivity analysis that excluded randomized clinical trials with a high risk of bias (shared frailty HR 0.91 (95% c.i. 0.72 to 1.15; P = 0.424)) and in the Bayesian analysis with a posterior shared frailty HR of 0.86 (95% c.i. 0.70 to 1.05). Conclusion: Neoadjuvant treatment does not demonstrate a survival advantage over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma.Oxford University PressDadun. Depósito Académico Digital Universidad de Navarra20242024-10-1520242024-01-0120242024-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/70166reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dadun.unav.edu:10171/701662026-06-21T12:47:57Z |
| dc.title.none.fl_str_mv |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials |
| title |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials |
| spellingShingle |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials Aliseda-Jover, D. (Daniel)|||/items/bfa542c5-12cf-4850-959a-d81305d560cd Neoadjuvant treatment Pancreatic ductal adenocarcinoma Bayesian meta-analysis |
| title_short |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials |
| title_full |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials |
| title_fullStr |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials |
| title_full_unstemmed |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials |
| title_sort |
Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials |
| dc.creator.none.fl_str_mv |
Aliseda-Jover, D. (Daniel)|||/items/bfa542c5-12cf-4850-959a-d81305d560cd Marti-Cruchaga, P. (Pablo)|||/items/97577c37-4c78-4a17-8b03-55eec0b40ff9 Zozaya-Larequi, G.N. (Gabriel Nicolás)|||/items/edce37f2-5ec6-40e5-996d-57a6e3ca7b0e Blanco, N. (Nuria)|||/items/98d5610d-0d00-4344-a7e3-ca9e2566cea7 Ponz-Sarvise, M. (Mariano)|||/items/2439c580-068e-431b-a20d-bdeab1b7c3ad Chopitea-Ortega, A. (Ana)|||/items/4234674f-5287-4a3a-a66e-8b82d25afe53 Castañón-Álvarez, E. (Eduardo)|||/items/6ef1df2b-d729-4ca8-af2e-dd81758ddd7a Pardo, F. (Fernando)|||/items/f4488eb3-3bf9-4dff-9d3f-402f36a1721e Rotellar-Sastre, F. (Fernando)|||/items/833cb788-f4b9-404d-a18b-ae1c84369b51 Rodríguez-Rodríguez, J. (Javier)|||/items/eb216e0c-3040-4db1-82a3-45514feafb00 |
| author |
Aliseda-Jover, D. (Daniel)|||/items/bfa542c5-12cf-4850-959a-d81305d560cd |
| author_facet |
Aliseda-Jover, D. (Daniel)|||/items/bfa542c5-12cf-4850-959a-d81305d560cd Marti-Cruchaga, P. (Pablo)|||/items/97577c37-4c78-4a17-8b03-55eec0b40ff9 Zozaya-Larequi, G.N. (Gabriel Nicolás)|||/items/edce37f2-5ec6-40e5-996d-57a6e3ca7b0e Blanco, N. (Nuria)|||/items/98d5610d-0d00-4344-a7e3-ca9e2566cea7 Ponz-Sarvise, M. (Mariano)|||/items/2439c580-068e-431b-a20d-bdeab1b7c3ad Chopitea-Ortega, A. (Ana)|||/items/4234674f-5287-4a3a-a66e-8b82d25afe53 Castañón-Álvarez, E. (Eduardo)|||/items/6ef1df2b-d729-4ca8-af2e-dd81758ddd7a Pardo, F. (Fernando)|||/items/f4488eb3-3bf9-4dff-9d3f-402f36a1721e Rotellar-Sastre, F. (Fernando)|||/items/833cb788-f4b9-404d-a18b-ae1c84369b51 Rodríguez-Rodríguez, J. (Javier)|||/items/eb216e0c-3040-4db1-82a3-45514feafb00 |
| author_role |
author |
| author2 |
Marti-Cruchaga, P. (Pablo)|||/items/97577c37-4c78-4a17-8b03-55eec0b40ff9 Zozaya-Larequi, G.N. (Gabriel Nicolás)|||/items/edce37f2-5ec6-40e5-996d-57a6e3ca7b0e Blanco, N. (Nuria)|||/items/98d5610d-0d00-4344-a7e3-ca9e2566cea7 Ponz-Sarvise, M. (Mariano)|||/items/2439c580-068e-431b-a20d-bdeab1b7c3ad Chopitea-Ortega, A. (Ana)|||/items/4234674f-5287-4a3a-a66e-8b82d25afe53 Castañón-Álvarez, E. (Eduardo)|||/items/6ef1df2b-d729-4ca8-af2e-dd81758ddd7a Pardo, F. (Fernando)|||/items/f4488eb3-3bf9-4dff-9d3f-402f36a1721e Rotellar-Sastre, F. (Fernando)|||/items/833cb788-f4b9-404d-a18b-ae1c84369b51 Rodríguez-Rodríguez, J. (Javier)|||/items/eb216e0c-3040-4db1-82a3-45514feafb00 |
| author2_role |
author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Dadun. Depósito Académico Digital Universidad de Navarra |
| dc.subject.none.fl_str_mv |
Neoadjuvant treatment Pancreatic ductal adenocarcinoma Bayesian meta-analysis |
| topic |
Neoadjuvant treatment Pancreatic ductal adenocarcinoma Bayesian meta-analysis |
| description |
Background: Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been established. The aim of this study was to compare long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma based on whether they received neoadjuvant treatment or underwent upfront surgery. Methods: A systematic review including randomized clinical trials on the overall survival outcomes between neoadjuvant treatment and upfront surgery in patients with resectable pancreatic ductal adenocarcinoma was conducted up to 1 August 2023 from PubMed, MEDLINE and Web of Science databases. Patient-level survival data was extracted and reconstructed from available Kaplan–Meier curves. A frequentist one-stage meta-analysis was employed, using Cox-based models and a non-parametric method (restricted mean survival time), to assess the difference in overall survival between groups. A Bayesian meta-analysis was also conducted. Results: Five randomized clinical trials comprising 625 patients were included. Among patients with resectable pancreatic ductal adenocarcinoma, neoadjuvant treatment was not significantly associated with a reduction in the hazard of death compared with upfront surgery (shared frailty HR 0.88, 95% c.i. 0.72 to 1.08, P = 0.223); this result was consistent in the non-parametric restricted mean survival time model (+2.41 months, 95% c.i. −1.22 to 6.04, P < 0.194), in the sensitivity analysis that excluded randomized clinical trials with a high risk of bias (shared frailty HR 0.91 (95% c.i. 0.72 to 1.15; P = 0.424)) and in the Bayesian analysis with a posterior shared frailty HR of 0.86 (95% c.i. 0.70 to 1.05). Conclusion: Neoadjuvant treatment does not demonstrate a survival advantage over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma. |
| publishDate |
2024 |
| dc.date.none.fl_str_mv |
2024 2024-10-15 2024 2024-01-01 2024 2024-01-01 |
| dc.type.none.fl_str_mv |
journal article http://purl.org/coar/resource_type/c_6501 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/10171/70166 |
| url |
https://hdl.handle.net/10171/70166 |
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Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
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open access http://purl.org/coar/access_right/c_abf2 |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 |
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openAccess |
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application/pdf |
| dc.publisher.none.fl_str_mv |
Oxford University Press |
| publisher.none.fl_str_mv |
Oxford University Press |
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reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra instname:Universidad de Navarra |
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Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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15,812429 |