The DOI matches its Crossref record; 3 of the 3 references it cites were found in a registry or an index.
Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer
Open accessAbstract
Background: Studies comparing upfront surgery with neoadjuvant treatment in pancreatic cancer may report only patients who underwent resection and so survival will be skewed. The aim of this study was to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in resectable or borderline resectable pancreatic cancer. Methods: MEDLINE, Embase and the Cochrane Library were searched for studies reporting median overall survival by intention to treat in patients with resectable or borderline resectable pancreatic cancer treated with or without neoadjuvant treatment. Secondary outcomes included overall and R0 resection rate, pathological lymph node rate, reasons for unresectability and toxicity of neoadjuvant treatment. Results: In total, 38 studies were included with 3484 patients, of whom 1738 (49·9 per cent) had neoadjuvant treatment. The weighted median overall survival by intention to treat was 18·8 months for neoadjuvant treatment and 14·8 months for upfront surgery; the difference was larger among patients whose tumours were resected (26·1 versus 15·0 months respectively). The overall resection rate was lower with neoadjuvant treatment than with upfront surgery (66·0 versus 81·3 per cent; P < 0·001), but the R0 rate was higher (86·8 (95 per cent c.i. 84·6 to 88·7) versus 66·9 (64·2 to 69·6) per cent; P < 0·001). Reported by intention to treat, the R0 rates were 58·0 and 54·9 per cent respectively (P = 0·088). The pathological lymph node rate was 43·8 per cent after neoadjuvant therapy and 64·8 per cent in the upfront surgery group (P < 0·001). Toxicity of at least grade III was reported in up to 64 per cent of the patients. Conclusion: Neoadjuvant treatment appears to improve overall survival by intention to treat, despite lower overall resection rates for resectable or borderline resectable pancreatic cancer. PROSPERO registration number: CRD42016049374.
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The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · BMJ · doi:10.1136/bmj.b2700 · Cited by 17,648
Intention-to-treat concept: A review
Gupta, S. (2011) · Perspectives in Clinical Research · doi:10.4103/2229-3485.83221 · Cited by 1,921
Cited by
Optimizing the outcomes of pancreatic cancer surgery
Strobel, O., Neoptolemos, J., Jäger, D., & Büchler, M. W. (2019) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-018-0112-1 · Cited by 943
Versteijne, E., van Dam, J. L., Suker, M., Janssen, Q. P., Groothuis, K., Akkermans-Vogelaar, J. M., Besselink, M. G., Bonsing, B. A., Buijsen, J., Busch, O. R., et al. (2022) · Journal of Clinical Oncology · doi:10.1200/jco.21.02233 · Cited by 786
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Metadata
- Authors
- Versteijne, E., Vogel, J. A., Besselink, M. G., Busch, O. R. C., Wilmink, J. W., Daams, J. G., van Eijck, C. H. J., Groot Koerkamp, B., Rasch, C. R. N., & van Tienhoven, G.
- Venue
- British Journal of Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-04-30
- Volume
- 105
- Issue
- 8
- Pages
- 946-958
- ISSN
- 0007-1323 (ISSN-L)
- 1365-2168
- OpenAlex
- W2799575632
- Cited by
- 519
- References
- 3
- FWCI
- 19.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
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- Versteijne, E., Vogel, J. A., Besselink, M. G., Busch, O. R. C., Wilmink, J. W., Daams, J. G., van Eijck, C. H. J., Groot Koerkamp, B., Rasch, C. R. N., & van Tienhoven, G. (2018). Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. British Journal of Surgery. https://doi.org/10.1002/bjs.10870
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