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Is Complete Pathologic Response in Pancreatic Cancer Overestimated? A Systematic Review of Prospective Studies
Antolino Laura1, Crovetto Anna1, Matteo Cinquepalmi2
1General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottorassa 1035, 00168, Rome, Italy.
Summary
Pathologic complete response in pancreatic cancer is infrequent. High-quality prospective studies reveal lower rates than retrospective reviews, suggesting overestimation in older data.
Area of Science:
- Oncology
- Gastroenterology
- Clinical Research
Background:
- Pathologic complete response (pCR) rates in pancreatic cancer (PaC) after neoadjuvant treatment (NADT) vary widely (0-33%) in existing literature.
- Current data predominantly stem from retrospective single-center reviews, potentially leading to overestimations.
- Accurate pCR incidence is crucial for evaluating NADT effectiveness in resectable, borderline resectable, and locally advanced PaC.
Purpose of the Study:
- To systematically review and assess the incidence of pathologic complete response (pCR) in pancreatic cancer following neoadjuvant therapy.
- To differentiate pCR rates between prospective and retrospective studies.
- To provide a more reliable estimate of neoadjuvant treatment efficacy in pancreatic cancer.
Main Methods:
- A systematic literature search was conducted following PRISMA guidelines, focusing on prospective studies of neoadjuvant treatment in pancreatic cancer.
- Retrospective studies, non-ductal carcinoma histologies, and trials including metastatic patients were excluded.
- Meta-analysis was performed using ProMeta3 Software; PROSPERO registry: CRD42018095641.
Main Results:
- Initial search identified 3128 papers; 1158 were eligible after filtering for human, recent (10 years), and English language articles.
- Twenty-seven papers were included in the final analysis.
- Overall pCR ranged from 0-11.11%, with a meta-analysis estimate of 4% (95% CI 3-5%). Prospective studies showed pCR rates of 0-9.09%.
Conclusions:
- Pathologic complete response in pancreatic cancer is infrequent.
- High-quality prospective studies offer a more reliable assessment of neoadjuvant treatment effects.
- Reported high pCR rates in selected retrospective studies are likely overestimated.
