Prognostic impact of resection margin status on survival after neoadjuvant treatment for pancreatic cancer: systematic review and meta-analysis
A greater than 1 mm tumour-free resection margin (R0 >1 mm) is a prognostic factor in upfront-resected pancreatic ductal adenocarcinoma. After neoadjuvant treatment (NAT); however, the prognostic impact of resection margin (R) status remains controversial. Randomised and non-randomised studies as...
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| Veröffentlicht in: | International journal of surgery (London, England) England), 2024-01, Vol.110 (1), p.453-463 |
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| container_title | International journal of surgery (London, England) |
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| creator | Leonhardt, Carl-Stephan Hank, Thomas Pils, Dietmar Gustorff, Charlotte Sahora, Klaus Schindl, Martin Verbeke, Caroline S Strobel, Oliver Klaiber, Ulla |
| description | A greater than 1 mm tumour-free resection margin (R0 >1 mm) is a prognostic factor in upfront-resected pancreatic ductal adenocarcinoma. After neoadjuvant treatment (NAT); however, the prognostic impact of resection margin (R) status remains controversial.
Randomised and non-randomised studies assessing the association of R status and survival in resected pancreatic ductal adenocarcinoma after NAT were sought by systematic searches of MEDLINE, Web of Science and CENTRAL. Hazard ratios (HR) and their corresponding 95% CI were collected to generate log HR using the inverse-variance method. Random-effects meta-analyses were performed and the results presented as weighted HR. Sensitivity and meta-regression analyses were conducted to account for different surgical procedures and varying length of follow-up, respectively.
Twenty-two studies with a total of 4929 patients were included. Based on univariable data, R0 greater than 1 mm was significantly associated with prolonged overall survival (OS) (HR 1.76, 95% CI 1.57-1.97; P |
| doi_str_mv | 10.1097/JS9.0000000000000792 |
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Randomised and non-randomised studies assessing the association of R status and survival in resected pancreatic ductal adenocarcinoma after NAT were sought by systematic searches of MEDLINE, Web of Science and CENTRAL. Hazard ratios (HR) and their corresponding 95% CI were collected to generate log HR using the inverse-variance method. Random-effects meta-analyses were performed and the results presented as weighted HR. Sensitivity and meta-regression analyses were conducted to account for different surgical procedures and varying length of follow-up, respectively.
Twenty-two studies with a total of 4929 patients were included. Based on univariable data, R0 greater than 1 mm was significantly associated with prolonged overall survival (OS) (HR 1.76, 95% CI 1.57-1.97; P<0.00001) and disease-free survival (DFS) (HR 1.66, 95% CI 1.39-1.97; P<0.00001). Using adjusted data, R0 greater than 1 mm was significantly associated with prolonged OS (HR 1.65, 95% CI 1.39-1.97; P<0.00001) and DFS (HR 1.76, 95% CI 1.30-2.39; P=0.0003). Results for R1 direct were comparable in the entire cohort; however, no prognostic impact was detected in sensitivity analysis including only partial pancreatoduodenectomies.
After NAT, a tumour-free margin greater than 1 mm is independently associated with improved OS as well as DFS in patients undergoing surgical resection for pancreatic cancer.</description><identifier>ISSN: 1743-9159</identifier><identifier>ISSN: 1743-9191</identifier><identifier>EISSN: 1743-9159</identifier><identifier>DOI: 10.1097/JS9.0000000000000792</identifier><identifier>PMID: 38315795</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Carcinoma, Pancreatic Ductal - mortality ; Carcinoma, Pancreatic Ductal - pathology ; Carcinoma, Pancreatic Ductal - surgery ; Carcinoma, Pancreatic Ductal - therapy ; Disease-Free Survival ; Humans ; Margins of Excision ; Neoadjuvant Therapy ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreatic Neoplasms - therapy ; Prognosis ; Reviews</subject><ispartof>International journal of surgery (London, England), 2024-01, Vol.110 (1), p.453-463</ispartof><rights>Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-3f18723a4a23725a3554234ba7b6801e6d4b9469899d1f81bf5fbb3b344c40713</citedby><cites>FETCH-LOGICAL-c434t-3f18723a4a23725a3554234ba7b6801e6d4b9469899d1f81bf5fbb3b344c40713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,26567,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38315795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leonhardt, Carl-Stephan</creatorcontrib><creatorcontrib>Hank, Thomas</creatorcontrib><creatorcontrib>Pils, Dietmar</creatorcontrib><creatorcontrib>Gustorff, Charlotte</creatorcontrib><creatorcontrib>Sahora, Klaus</creatorcontrib><creatorcontrib>Schindl, Martin</creatorcontrib><creatorcontrib>Verbeke, Caroline S</creatorcontrib><creatorcontrib>Strobel, Oliver</creatorcontrib><creatorcontrib>Klaiber, Ulla</creatorcontrib><title>Prognostic impact of resection margin status on survival after neoadjuvant treatment for pancreatic cancer: systematic review and meta-analysis</title><title>International journal of surgery (London, England)</title><addtitle>Int J Surg</addtitle><description>A greater than 1 mm tumour-free resection margin (R0 >1 mm) is a prognostic factor in upfront-resected pancreatic ductal adenocarcinoma. After neoadjuvant treatment (NAT); however, the prognostic impact of resection margin (R) status remains controversial.
Randomised and non-randomised studies assessing the association of R status and survival in resected pancreatic ductal adenocarcinoma after NAT were sought by systematic searches of MEDLINE, Web of Science and CENTRAL. Hazard ratios (HR) and their corresponding 95% CI were collected to generate log HR using the inverse-variance method. Random-effects meta-analyses were performed and the results presented as weighted HR. Sensitivity and meta-regression analyses were conducted to account for different surgical procedures and varying length of follow-up, respectively.
Twenty-two studies with a total of 4929 patients were included. Based on univariable data, R0 greater than 1 mm was significantly associated with prolonged overall survival (OS) (HR 1.76, 95% CI 1.57-1.97; P<0.00001) and disease-free survival (DFS) (HR 1.66, 95% CI 1.39-1.97; P<0.00001). Using adjusted data, R0 greater than 1 mm was significantly associated with prolonged OS (HR 1.65, 95% CI 1.39-1.97; P<0.00001) and DFS (HR 1.76, 95% CI 1.30-2.39; P=0.0003). Results for R1 direct were comparable in the entire cohort; however, no prognostic impact was detected in sensitivity analysis including only partial pancreatoduodenectomies.
After NAT, a tumour-free margin greater than 1 mm is independently associated with improved OS as well as DFS in patients undergoing surgical resection for pancreatic cancer.</description><subject>Carcinoma, Pancreatic Ductal - mortality</subject><subject>Carcinoma, Pancreatic Ductal - pathology</subject><subject>Carcinoma, Pancreatic Ductal - surgery</subject><subject>Carcinoma, Pancreatic Ductal - therapy</subject><subject>Disease-Free Survival</subject><subject>Humans</subject><subject>Margins of Excision</subject><subject>Neoadjuvant Therapy</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreatic Neoplasms - therapy</subject><subject>Prognosis</subject><subject>Reviews</subject><issn>1743-9159</issn><issn>1743-9191</issn><issn>1743-9159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>3HK</sourceid><recordid>eNpdUctuFDEQtBCIhMAfIOQjlwl-rsdcEIp4KhJIwNnq8diLoxl7sT0T7Vfwy3jJQwu-dKvaXd1dhdBzSs4p0erV52_6nBw_pdkDdEqV4J2mUj88yk_Qk1KuCBGkp_1jdMJ7TqXS8hT9_prTNqZSg8Vh3oGtOHmcXXG2hhTxDHkbIi4V6lJwA8qS17DChMFXl3F0CcarZYVYcc0O6uxa5lPGO4j2ADRi21KXX-OyL9XNf6Hs1uCuMcQRz65CBxGmfQnlKXrkYSru2W08Qz_ev_t-8bG7_PLh08Xby84KLmrHPe0V4yCAccUkcCkF42IANWx6Qt1mFIMWG91rPVLf08FLPwx84EJYQRTlZ-jNDe9uGWY32rZ1hsnscmgX702CYP6txPDTbNNqaNO5yacaA75hsDk0-aKJKUMr95IZSiVhhyEvb4fk9GtxpZo5FOumCZpsSzFMM6Yl0Uy0r-KOLZWSnb9fhRJz8Ns0v83_fre2F8dn3DfdGcz_APuGqHg</recordid><startdate>20240101</startdate><enddate>20240101</enddate><creator>Leonhardt, Carl-Stephan</creator><creator>Hank, Thomas</creator><creator>Pils, Dietmar</creator><creator>Gustorff, Charlotte</creator><creator>Sahora, Klaus</creator><creator>Schindl, Martin</creator><creator>Verbeke, Caroline S</creator><creator>Strobel, Oliver</creator><creator>Klaiber, Ulla</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>3HK</scope><scope>5PM</scope></search><sort><creationdate>20240101</creationdate><title>Prognostic impact of resection margin status on survival after neoadjuvant treatment for pancreatic cancer: systematic review and meta-analysis</title><author>Leonhardt, Carl-Stephan ; Hank, Thomas ; Pils, Dietmar ; Gustorff, Charlotte ; Sahora, Klaus ; Schindl, Martin ; Verbeke, Caroline S ; Strobel, Oliver ; Klaiber, Ulla</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-3f18723a4a23725a3554234ba7b6801e6d4b9469899d1f81bf5fbb3b344c40713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Carcinoma, Pancreatic Ductal - mortality</topic><topic>Carcinoma, Pancreatic Ductal - pathology</topic><topic>Carcinoma, Pancreatic Ductal - surgery</topic><topic>Carcinoma, Pancreatic Ductal - therapy</topic><topic>Disease-Free Survival</topic><topic>Humans</topic><topic>Margins of Excision</topic><topic>Neoadjuvant Therapy</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreatic Neoplasms - therapy</topic><topic>Prognosis</topic><topic>Reviews</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leonhardt, Carl-Stephan</creatorcontrib><creatorcontrib>Hank, Thomas</creatorcontrib><creatorcontrib>Pils, Dietmar</creatorcontrib><creatorcontrib>Gustorff, Charlotte</creatorcontrib><creatorcontrib>Sahora, Klaus</creatorcontrib><creatorcontrib>Schindl, Martin</creatorcontrib><creatorcontrib>Verbeke, Caroline S</creatorcontrib><creatorcontrib>Strobel, Oliver</creatorcontrib><creatorcontrib>Klaiber, Ulla</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of surgery (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leonhardt, Carl-Stephan</au><au>Hank, Thomas</au><au>Pils, Dietmar</au><au>Gustorff, Charlotte</au><au>Sahora, Klaus</au><au>Schindl, Martin</au><au>Verbeke, Caroline S</au><au>Strobel, Oliver</au><au>Klaiber, Ulla</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic impact of resection margin status on survival after neoadjuvant treatment for pancreatic cancer: systematic review and meta-analysis</atitle><jtitle>International journal of surgery (London, England)</jtitle><addtitle>Int J Surg</addtitle><date>2024-01-01</date><risdate>2024</risdate><volume>110</volume><issue>1</issue><spage>453</spage><epage>463</epage><pages>453-463</pages><issn>1743-9159</issn><issn>1743-9191</issn><eissn>1743-9159</eissn><abstract>A greater than 1 mm tumour-free resection margin (R0 >1 mm) is a prognostic factor in upfront-resected pancreatic ductal adenocarcinoma. After neoadjuvant treatment (NAT); however, the prognostic impact of resection margin (R) status remains controversial.
Randomised and non-randomised studies assessing the association of R status and survival in resected pancreatic ductal adenocarcinoma after NAT were sought by systematic searches of MEDLINE, Web of Science and CENTRAL. Hazard ratios (HR) and their corresponding 95% CI were collected to generate log HR using the inverse-variance method. Random-effects meta-analyses were performed and the results presented as weighted HR. Sensitivity and meta-regression analyses were conducted to account for different surgical procedures and varying length of follow-up, respectively.
Twenty-two studies with a total of 4929 patients were included. Based on univariable data, R0 greater than 1 mm was significantly associated with prolonged overall survival (OS) (HR 1.76, 95% CI 1.57-1.97; P<0.00001) and disease-free survival (DFS) (HR 1.66, 95% CI 1.39-1.97; P<0.00001). Using adjusted data, R0 greater than 1 mm was significantly associated with prolonged OS (HR 1.65, 95% CI 1.39-1.97; P<0.00001) and DFS (HR 1.76, 95% CI 1.30-2.39; P=0.0003). Results for R1 direct were comparable in the entire cohort; however, no prognostic impact was detected in sensitivity analysis including only partial pancreatoduodenectomies.
After NAT, a tumour-free margin greater than 1 mm is independently associated with improved OS as well as DFS in patients undergoing surgical resection for pancreatic cancer.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>38315795</pmid><doi>10.1097/JS9.0000000000000792</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; NORA - Norwegian Open Research Archives; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Carcinoma, Pancreatic Ductal - mortality Carcinoma, Pancreatic Ductal - pathology Carcinoma, Pancreatic Ductal - surgery Carcinoma, Pancreatic Ductal - therapy Disease-Free Survival Humans Margins of Excision Neoadjuvant Therapy Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreatic Neoplasms - therapy Prognosis Reviews |
| title | Prognostic impact of resection margin status on survival after neoadjuvant treatment for pancreatic cancer: systematic review and meta-analysis |
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