Influence of resection margins and treatment on survival in patients with pancreatic cancer - Meta-analysis of randomized controlled trials

Objective: To assess the influence of resection margins and adjuvant chemoradiotherapy or chemotherapy on survival for patients with pancreatic cancer by meta-analysis of individual data from randomized controlled trials. Data Sources: Structured MEDLINE search for published studies. Study Selection: A meta-analysis of published randomized controlled trials and individual data. Data Extraction: Individual data were obtained from 4 recently published trials (875 patients: 278 [32%] with RI and 591 [68%] with R0 resections). Data Synthesis: Kaplan-Meier estimates of survival were compared using log-rank analyses. Pooled hazard ratios of the effects of chemoradiotherapy and chemotherapy treatments on the risk of death were calculated separately and across groups according to resection margins status. Six hundred ninety-eight patients (80%) had died, with a median follow-up of 44 months in the surviving patients. Resection margin involvement was not a significant factor for survival (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.94-1.29; log-rank chi(2)= 1.4; P =.24). The 2- and 5-year survival rates, respectively, were 33% and 16% for R0 patients and 29% and 15% for RI patients. Chemoradiotherapy in RI patients resulted in a 28% reduction in the risk of death (HR, 0.72; 95% CI, 0.47-1.10) compared with a 19% increased risk in R0 patients (HR, 1.19; 95% Cl, 0.95-1.49). Chemotherapy in RI patients had a 4% increased risk of death (HR, 1.04; 95% Cl, 0.78-1.40) compared with a 35% reduction in risk in the R0 subgroup (HR, 0.65; 95% Cl, 0.53-0.80). Conclusion: Adjuvant chemotherapy but not chemoradiotherapy should be the standard of care for patients with either R0 or R1 resections for pancreatic cancer.