Does adjuvant therapy improve survival in patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma? A systematic review, meta-analysis and meta-regression.

IF 2.2 3区 医学 Q2 SURGERY
G Nappo, V D'Ambra, C Ricci, M Pagnanelli, V Rebasti, G Alves, S Crippa, L Rimassa, R Casadei, A Zerbi
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Abstract

The role of adjuvant therapy (AT) after pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DC) remains controversial. This systematic review and meta-analysis aimed to evaluate the impact of AT on overall survival (OS) and disease-free survival (DFS) in patients with resected DC. A systematic review was conducted following PRISMA guidelines (PROSPERO: CRD42024561780). PubMed, Scopus, Web of Science, and Cochrane databases were searched for studies published between January 2000 and August 2023. Eligible studies included patients who underwent PD for DC, comparing AT to follow-up (FUP) alone. Primary endpoints were OS and DFS, analyzed using hazard ratios (HR) with 95% confidence intervals (CI). Meta-regression explored potential sources of heterogeneity. The analysis included 22 studies with 7078 patients (3860 FUP group, 3218 AT group): of the studies, only 3 (13.6%) were RCTs (even if none of them was specifically designed for DC). AT significantly improved OS (HR 0.80; 95% CI 0.73-0.89; p < 0.001) and DFS (HR 0.84; 95% CI 0.74-0.96; p = 0.023) compared to FUP. Subgroup analysis showed a greater benefit for chemo-radiotherapy (OS HR 0.81; 95% CI 0.72-0.91) over chemotherapy alone (OS HR 0.78; 95% CI 0.64-0.94). High heterogeneity (I2 = 98%) was identified among the included studies. This meta-analysis demonstrates that AT is associated with improved survival outcomes in patients undergoing PD for DC. However, the significant limitations of the existing literature, particularly the lack of RCTs designed specifically for DC, necessitate caution, especially on which type of chemotherapy should be adopted.

辅助治疗是否能提高远端胆管癌胰十二指肠切除术患者的生存率?系统回顾、元分析和元回归。
胰十二指肠切除术(PD)后辅助治疗(AT)在远端胆管癌(DC)中的作用仍然存在争议。本系统综述和荟萃分析旨在评估AT对切除DC患者总生存期(OS)和无病生存期(DFS)的影响。按照PRISMA指南(PROSPERO: CRD42024561780)进行了系统评价。检索了PubMed、Scopus、Web of Science和Cochrane数据库中2000年1月至2023年8月间发表的研究。符合条件的研究包括接受PD治疗的DC患者,比较AT和单独随访(FUP)。主要终点为OS和DFS,使用风险比(HR)和95%置信区间(CI)进行分析。元回归分析了异质性的潜在来源。该分析包括22项研究,7078例患者(FUP组3860例,AT组3218例):其中只有3项(13.6%)是随机对照试验(即使没有一项是专门为DC设计的)。在纳入的研究中,发现AT显著改善了OS (HR 0.80; 95% CI 0.73-0.89; p 2 = 98%)。这项荟萃分析表明,AT与接受PD治疗的DC患者的生存率改善有关。然而,现有文献的显著局限性,特别是缺乏专门为DC设计的随机对照试验,需要谨慎,特别是应采用哪种化疗类型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Updates in Surgery
Updates in Surgery Medicine-Surgery
CiteScore
4.50
自引率
7.70%
发文量
208
期刊介绍: Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future. Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts. Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.
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