Survival After Irreversible Electroporation in Unresectable Locally Advanced Pancreatic Cancer: A Meta-analysis

To evaluate the overall survival (OS) time and predictors of survival in patients with unresectable locally advanced pancreatic ductal adenocarcinoma (PDAC) who were treated with irreversible electroporation (IRE).

According to PRISMA guidelines, a systematic review and random-effects meta-analysis (single-arm and comparison) with meta-regression was conducted. All studies reporting OS time after IRE in patients with unresectable locally advanced PDAC were included.

Thirty-one studies including 1296 patients were included. The OS time after IRE was 16.3 mo (95% CI: 14.2-18.4); it was longer in patients who received IRE than in those who did not (mean difference: 6.97 mo, 95% CI: 0.79-13.15, P = 0.03). The OS time was not affected by age (coefficient: -0.088, P = 0.722), male sex (coefficient: -0.049, P = 0.314), tumor size (coefficient: -0.049, P = 0.710), tumors located in the head of pancreas (coefficient: -3.141, P = 0.696), tumors located in the body or tail of pancreas (coefficient: 2.498, P = 0.747), and pretreatment chemotherapy (coefficient: 3.378, P = 0.233). Subgroup analyses showed that OS time was not affected by surgical (18.1 mo, 95% CI: 13.4-22.9) or percutaneous (14.9 mo, 95% CI: 12.2-17.6) approaches used or when IRE was combined with immunotherapy (20.3 mo, 95% CI: 5.4-35.2) or chemotherapy (18.5 mo, 95% CI: 15.5-21.4).

IRE may improve OS time in patients with unresectable locally advanced PDAC (low-to-moderate certainty). The results of current study support the rationale for conducting future randomized trials in this setting and provide a robust basis for hypothesis generation and power analysis.