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Neoadjuvant/Preoperative Gemcitabine for Patients with Localized Pancreatic Cancer: A Meta-analysis of Prospective Studies

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Long-term prognosis for localized pancreatic cancer remains poor. We sought to assess the benefit of neoadjuvant/preoperative chemotherapy with or without radiotherapy.

Methods

Prospective studies where gemcitabine with or without radiotherapy was provided before surgery in patients with initially resectable or unresectable disease were reviewed by meta-analysis. Primary outcome was survival, and secondary outcomes were tumor response after therapy, toxicity, surgical exploration, and resection rates.

Results

Twenty independent studies with 707 participants were included, 366 with resectable lesions and 341 with unresectable lesions. Seven studies were phase I/II trials, 10 phase II, and 3 prospective cohort studies. Estimated 1- and 2-year survival probabilities after resection were 91.7% (95% confidence interval [CI] 75–100) and 67.2% (95% CI 38–87) for initially resectable patients, and 86.3% (95% CI 78–100) and 54.2% (95% CI 25–100) for initially unresectable patients. The complete/partial response rate was 12% (95% CI 4–23) and 27% (95% CI 18–38) in resectable and unresectable lesions, respectively. The rate of treatment-related grade 3–4 toxicity was 31% (95% CI 21–42). Of resectable patients evaluable after restaging, 91% (95% CI 83–97) underwent surgery, and 82% (95% CI 65–95) of explored patients underwent resection. R0 resections amounted to 89% (95% CI 83–94). Of unresectable patients evaluable after restaging, 39% (95% CI 28–50) underwent surgery, and 68% (95% CI 53–82) of explored patients were resected, with 60% (95% CI 50–71) R0 resections.

Conclusions

Current analysis provides marginal support to the assumed benefits of neoadjuvant therapies for patients with resectable cancer, and indicates a potential advantage only for a minority of those with unresectable lesions.

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Acknowledgment

The meta-analysis was designed and results were analyzed without financial support from producers of any drugs used in the study.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy

    Angelo Andriulli MD & Maria R. Valvano MSc

  2. Division of Gastroenterology, “San Filippo Neri” Hospital, Rome, Italy

    Virginia Festa MD & Maurizio Koch MD

  3. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Edoardo Botteri MSc & Patrick Maisonneuve Eng

  4. University of Milan, Istituto di Statistica Medica e Biometria “G.A. Maccacaro,”, Milan, Italy

    Edoardo Botteri MSc

  5. Department of Surgery, University Hospital, Verona, Italy

    Claudio Bassi MD

  6. Department of Surgery, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy

    Pierluigi Di Sebastiano MD

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  1. Angelo Andriulli MD
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  2. Virginia Festa MD
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  4. Maria R. Valvano MSc
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Corresponding author

Correspondence to Virginia Festa MD.

Appendix

Appendix

See Tables 4 and 5.

Table 4 Prisma 2009 check-list
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Table 5 Quality assessment of selected trials, according to the Downs and Black’ scale
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Andriulli, A., Festa, V., Botteri, E. et al. Neoadjuvant/Preoperative Gemcitabine for Patients with Localized Pancreatic Cancer: A Meta-analysis of Prospective Studies. Ann Surg Oncol 19, 1644–1662 (2012). https://doi.org/10.1245/s10434-011-2110-8

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  • DOI: https://doi.org/10.1245/s10434-011-2110-8

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