CT in the prediction of margin-negative resection in pancreatic cancer following neoadjuvant treatment: a systematic review and meta-analysis

Objectives We aimed to systematically evaluate the diagnostic accuracy of CT-determined resectability following neoadjuvant treatment for predicting margin-negative resection (R0 resection) in patients with pancreatic ductal adenocarcinoma (PDAC). Methods Original studies with sufficient details to obtain the sensitivity and specificity of CT-determined resectability following neoadjuvant treatment, with a reference on the pathological margin status, were identified in PubMed, EMBASE, and Cochrane databases until February 24, 2020. The identified studies were divided into two groups based on the criteria of R0 resectable tumor (ordinary criterion: resectable PDAC alone; extended criterion: resectable and borderline resectable PDAC). The meta-analytic summary of the sensitivity and specificity for each criterion was estimated separately using a bivariate random-effect model. Summary results of the two criteria were compared using a joint-model bivariate meta-regression. Results Of 739 studies initially searched, 6 studies (6 with ordinary criterion and 5 with extended criterion) were included for analysis. The meta-analytic summary of sensitivity and specificity was 45% (95% confidence interval [CI], 19-73%; I-2 = 88.3%) and 85% (95% CI, 65-94%; I-2 = 60.5%) for the ordinary criterion, and 81% (95% CI, 71-87%; I-2 = 0.0%) and 42% (95% CI, 28-57%; I-2 = 6.2%) for the extended criterion, respectively. The diagnostic accuracy significantly differed between the two criteria (p = 0.02). Conclusions For determining resectability on CT, the ordinary criterion might be highly specific but insensitive for predicting R0 resection, whereas the extended criterion increased sensitivity but would decrease specificity. Further investigations using quantitative parameters may improve the identification of R0 resection.

Automated summary

The study systematically evaluated the diagnostic accuracy of CT-determined resectability after neoadjuvant treatment for predicting margin-negative resection in patients with PDAC. The research found that the ordinary criterion for resectability on CT was highly specific but insensitive in predicting R0 resection, while the extended criterion increased sensitivity but decreased specificity. Further investigations using quantitative parameters may improve the identification of R0 resection.