S W L de Geus1, D B Evans2, L A Bliss3, M F Eskander4, J K Smith5, R A Wolff6, R A Miksad7, M C Weinstein8, J F Tseng9. 1. Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: S.W.L.de_geus@lumc.nl. 2. Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. Electronic address: devans@mcw.edu. 3. Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: lindsay.bliss@gmail.com. 4. Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: meskande@bidmc.harvard.edu. 5. Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: jkennedysmith@gmail.com. 6. Department of Gastrointestinal Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: rwolff@mdanderson.org. 7. Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: rmiksad@bidmc.harvard.edu. 8. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Electronic address: mcw@hsph.harvard.edu. 9. Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: jftseng@bidmc.harvard.edu.
Abstract
BACKGROUND: Neoadjuvant therapy is gaining acceptance as a valid treatment option for borderline resectable pancreatic cancer; however, its value for clearly resectable pancreatic cancer remains controversial. The aim of this study was to use a Markov decision analysis model, in the absence of adequately powered randomized trials, to compare the life expectancy (LE) and quality-adjusted life expectancy (QALE) of neoadjuvant therapy to conventional upfront surgical strategies in resectable pancreatic cancer patients. METHODS: A Markov decision model was created to compare two strategies: attempted pancreatic resection followed by adjuvant chemoradiotherapy and neoadjuvant chemoradiotherapy followed by restaging with, if appropriate, attempted pancreatic resection. Data obtained through a comprehensive systematic search in PUBMED of the literature from 2000 to 2015 were used to estimate the probabilities used in the model. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Of the 786 potentially eligible studies identified, 22 studies met the inclusion criteria and were used to extract the probabilities used in the model. Base case analyses of the model showed a higher LE (32.2 vs. 26.7 months) and QALE (25.5 vs. 20.8 quality-adjusted life months) for patients in the neoadjuvant therapy arm compared to upfront surgery. Probabilistic sensitivity analyses for LE and QALE revealed that neoadjuvant therapy is favorable in 59% and 60% of the cases respectively. CONCLUSION(S): Although conceptual, these data suggest that neoadjuvant therapy offers substantial benefit in LE and QALE for resectable pancreatic cancer patients. These findings highlight the value of further prospective randomized trials comparing neoadjuvant therapy to conventional upfront surgical strategies.
BACKGROUND: Neoadjuvant therapy is gaining acceptance as a valid treatment option for borderline resectable pancreatic cancer; however, its value for clearly resectable pancreatic cancer remains controversial. The aim of this study was to use a Markov decision analysis model, in the absence of adequately powered randomized trials, to compare the life expectancy (LE) and quality-adjusted life expectancy (QALE) of neoadjuvant therapy to conventional upfront surgical strategies in resectable pancreatic cancerpatients. METHODS: A Markov decision model was created to compare two strategies: attempted pancreatic resection followed by adjuvant chemoradiotherapy and neoadjuvant chemoradiotherapy followed by restaging with, if appropriate, attempted pancreatic resection. Data obtained through a comprehensive systematic search in PUBMED of the literature from 2000 to 2015 were used to estimate the probabilities used in the model. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Of the 786 potentially eligible studies identified, 22 studies met the inclusion criteria and were used to extract the probabilities used in the model. Base case analyses of the model showed a higher LE (32.2 vs. 26.7 months) and QALE (25.5 vs. 20.8 quality-adjusted life months) for patients in the neoadjuvant therapy arm compared to upfront surgery. Probabilistic sensitivity analyses for LE and QALE revealed that neoadjuvant therapy is favorable in 59% and 60% of the cases respectively. CONCLUSION(S): Although conceptual, these data suggest that neoadjuvant therapy offers substantial benefit in LE and QALE for resectable pancreatic cancerpatients. These findings highlight the value of further prospective randomized trials comparing neoadjuvant therapy to conventional upfront surgical strategies.
Authors: Vincent P Groot; Georgios Gemenetzis; Alex B Blair; Roberto J Rivero-Soto; Jun Yu; Ammar A Javed; Richard A Burkhart; Inne H M Borel Rinkes; I Quintus Molenaar; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: Ann Surg Date: 2018-03-23 Impact factor: 12.969
Authors: Susanna W L de Geus; Gyulnara G Kasumova; Mariam F Eskander; Sing Chau Ng; Tara S Kent; A James Moser; Alexander L Vahrmeijer; Mark P Callery; Jennifer F Tseng Journal: J Gastrointest Surg Date: 2017-10-04 Impact factor: 3.452
Authors: Camila S Padilha; Poliana Camila Marinello; Daniel A Galvão; Robert U Newton; Fernando H Borges; Fernando Frajacomo; Rafael Deminice Journal: J Cancer Surviv Date: 2017-01-04 Impact factor: 4.442
Authors: Vincent P Groot; Georgios Gemenetzis; Alex B Blair; Roberto J Rivero-Soto; Jun Yu; Ammar A Javed; Richard A Burkhart; Inne H M Borel Rinkes; I Quintus Molenaar; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: Ann Surg Date: 2019-06 Impact factor: 13.787