- A meta-analysis suggests neoadjuvant therapy (NAT) confers better survival advantage than upfront surgery followed by adjuvant chemotherapy in resectable pancreatic cancer.
Why this matters
- The authors attempted to compensate for selection bias, which may have plagued previous retrospective studies.
- Meta-analysis (14 studies; n=2699 neoadjuvant therapy, 6992 upfront surgery).
- Funding: Korean government.
- NAT was associated with better OS in resectable disease (HR, 0.80; P=.002), but there was significant heterogeneity in the included studies (chi2=21.02; P=.070; I2=38%).
- In subanalyses designed to reduce selection bias, there was a significant advantage with NAT in a per protocol analysis (12 studies; HR, 0.72; P<.001 but not in an intention-to-treat analysis studies hr p=".610).</li">
- The loss of survival advantage in the ITT analysis may be the result of a higher presurgical attrition rate in the NAT group (36.3% vs 17.3%).
- 4 studies looked at NAT followed by resection (n=2177) and surgery followed by adjuvant chemotherapy (n=4545). A meta-analysis showed a survival advantage with NAT (HR, 0.82; P<.01 with no significant between-study heterogeneity>2=3.57; P=.310; I2=16%).
- Included studies were retrospective.