Prognostic Factors for Early Recurrence After Resection of Pancreatic Cancer: A Systematic Review and Meta-Analysis,Gastroenterology

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Prognostic Factors for Early Recurrence After Resection of Pancreatic Cancer: A Systematic Review and Meta-Analysis
Gastroenterology ( IF 25.7 ) Pub Date : 2024-05-31 , DOI: 10.1053/j.gastro.2024.05.028
Carl-Stephan Leonhardt ₁ , Charlotte Gustorff ₂ , Ulla Klaiber ₂ , Solange Le Blanc ₂ , Tanja A Stamm ₃ , Caroline S Verbeke ₄ , Gerald W Prager ₅ , Oliver Strobel ₂

Affiliation

Background & Aims

More than half of pancreatic ductal adenocarcinomas (PDACs) recur within 12 months after curative-intent resection. This systematic review and meta-analysis was conducted to identify all reported prognostic factors for early recurrence in resected PDACs.

Methods

After a systematic literature search, a meta-analysis was conducted using a random effects model. Separate analyses were performed for adjusted vs unadjusted effect estimates as well as reported odds ratios (ORs) and hazard ratios (HRs). Risk of bias was assessed using the Quality in Prognostic Studies tool, and evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation recommendations.

Results

After 2903 abstracts were screened, 65 studies were included. Of these, 28 studies (43.1%) defined early recurrence as evidence of recurrence within 6 months, whereas 34 (52.3%) defined it as evidence of recurrence within 12 months after surgery. Other definitions were uncommon. Analysis of unadjusted ORs and HRs revealed 41 and 5 prognostic factors for early recurrence within 6 months, respectively. When exclusively considering adjusted data, we identified 25 and 10 prognostic factors based on OR and HR, respectively. Using a 12-month definition, we identified 38 (OR) and 15 (HR) prognostic factors from unadjusted data and 38 (OR) and 30 (HR) prognostic factors from adjusted data, respectively. On the basis of frequency counts of adjusted data, preoperative carbohydrate antigen 19-9, N status, nondelivery of adjuvant therapy, grading, and tumor size based on imaging were identified as key prognostic factors for early recurrence.

Conclusions

Reported prognostic factors of early recurrence vary considerably. Identified key prognostic factors could aid in the development of a risk stratification framework for early recurrence. However, prospective validation is necessary.

中文翻译：

胰腺癌切除术后早期复发的预后因素：系统评价和荟萃分析

背景和目标

超过一半的胰腺导管腺癌（PDAC）在根治性切除术后 12 个月内复发。进行本系统评价和荟萃分析，以确定所有已报道的切除 PDAC 早期复发的预后因素。

方法

经过系统的文献检索，使用随机效应模型进行荟萃分析。对调整后与未调整的效果估计值以及报告的比值比（ORs）和风险比（HRs）进行单独分析。使用预后研究质量工具评估偏倚风险，并根据建议分级评估、开发和评估建议对证据进行评级。

结果

筛选出 2903 篇摘要后，共纳入 65 篇研究。其中，28 项研究（43.1%）将其早期复发定义为 6 个月内复发的证据，而 34 项研究（52.3%）将其定义为手术后 12 个月内复发的证据。其他定义并不常见。对未调整的 ORs 和 HR 的分析揭示了 6 个月内早期复发的 41 个和 5 个预后因素。当仅考虑调整后的数据时，我们分别基于 OR 和 HR 确定了 25 个和 10 个预后因素。使用 12 个月的定义，我们从未调整数据中分别确定了 38 个（OR）和 15 个（HR）预后因素，从调整数据中分别确定了 38 个（OR）和 30 个（HR）预后因素。根据调整数据的频率计数，术前碳水化合物抗原 19-9 、 N 状态、辅助治疗未实施、分级和基于影像学的肿瘤大小被确定为早期复发的关键预后因素。