title: Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To assess the influence of resection margins and adjuvant chemoradiotherapy or chemotherapy on survival for patients with pancreatic cancer by meta-analysis of individual data from randomized controlled trials.
  
  
  METHODS
  Structured MEDLINE search for published studies.
  
  
  METHODS
  A meta-analysis of published randomized controlled trials and individual data.
  
  
  METHODS
  Individual data were obtained from 4 recently published trials (875 patients: 278 [32%] with R1 and 591 [68%] with R0 resections).
  
  
  RESULTS
  Kaplan-Meier estimates of survival were compared using log-rank analyses. Pooled hazard ratios of the effects of chemoradiotherapy and chemotherapy treatments on the risk of death were calculated separately and across groups according to resection margins status. Six hundred ninety-eight patients (80%) had died, with a median follow-up of 44 months in the surviving patients. Resection margin involvement was not a significant factor for survival (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.94-1.29; log-rank chi(2) = 1.4; P = .24). The 2- and 5-year survival rates, respectively, were 33% and 16% for R0 patients and 29% and 15% for R1 patients. Chemoradiotherapy in R1 patients resulted in a 28% reduction in the risk of death (HR, 0.72; 95% CI, 0.47-1.10) compared with a 19% increased risk in R0 patients (HR, 1.19; 95% CI, 0.95-1.49). Chemotherapy in R1 patients had a 4% increased risk of death (HR, 1.04; 95% CI, 0.78-1.40) compared with a 35% reduction in risk in the R0 subgroup (HR, 0.65; 95% CI, 0.53-0.80).
  
  
  CONCLUSIONS
  Adjuvant chemotherapy but not chemoradiotherapy should be the standard of care for patients with either R0 or R1 resections for pancreatic cancer.
authors.affiliation: Division of Surgery and Oncology, School of Cancer Studies, Royal Liverpool University Hospital, 5th Floor, UCD Bldg, Daulby St, Liverpool L69 3GA, England. j.p.neoptolemos@liverpool.ac.uk
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.forename: Deborah D
authors.initials: DD
authors.lastname: Stocken
authors.forename: Moritz N
authors.initials: MN
authors.lastname: Wente
authors.forename: Hans
authors.initials: H
authors.lastname: Jeekel
authors.forename: Johaness H G
authors.initials: JH
authors.lastname: Klinkenbijl
authors.forename: Kåre E
authors.initials: KE
authors.lastname: Bakkevold
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Hirano
authors.initials: H
authors.lastname: Amano
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002423:Cause of Death; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors