Adjuvant Therapy In Resected Pancreatic Cancer: A Systematic Review Of Literature With Meta-Analysis Of Randomized Clinical Trials

342 Background: To assess the role of adjuvant treatments (AT), adjuvant chemotherapy (AC) and adjuvant chemo-radiotherapy (ACR) in resected pancreatic adenocarcinoma. Methods: A systematic review of literature in the MEDLINE and EMBASE data bases from 1966 to 2011 was independently performed by two authors (FD and DT). All the randomized phase III trials investigating the role of AT in radically resected pancreatic cancer were considered eligible and included into the pooled analysis. 5-year-survival rate in patients treated with AT was the primary end point of the trial, 5-year-survival rate of patients treated with AC and ACR, and the 5-year-survival number needed to treat (NNT) of AT, AC and ACR were the secondary ones. Results: The outcomes of 1402 patients enrolled in 8 trials were compared in the pooled analysis. 816 patients were treated with AT (540 with AC and 276 with ACR), and 586 were enrolled in the control arm (no adjuvant treatment). Significant improve in 5-year-survival rate was observed for AT and AC (odds ratio of 0.636, p<0.05 and 0.422, p<0.01 respectively), but not for ACR (odds ratio=1.139, p=0.489), with a 5-year survival NNT of 20, 10 and 38 respectively for AT, AC and ACR. Low to moderate heterogeneity between the trials was documented both for AT (I 2 =58%) and AC (I 2 =31.63%), but not for ACR (I 2 =0%,). Conclusions: Our data confirm that adjuvant chemotherapy improves the 5-year survival rate in radically resected cancer patients and gemctabine based regimens seem to be better than FU based regimens.