Evidence map›Paper›PMID 11729382›Full record

Trial reportAnnals of surgery2001

Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial.

J P Neoptolemos, D D Stocken, J A Dunn, J Almond, H G Beger, P Pederzoli, C Bassi, C Dervenis, L Fernandez-Cruz, F Lacaine and 14 more

Registry-linked trialAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of surgery, 2001. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00763516 (A Pilot Study Using Neoadjuvant Proton Beam Radiation Therapy and Chemotherapy for Marginally Resectable Carcinoma of the Pancreas), which is not on this map. Cited by 185 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
185citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00763516 nacompletednot on this mapstarted 2009, after this paper: background citation

A Pilot Study Using Neoadjuvant Proton Beam Radiation Therapy and Chemotherapy for Marginally Resectable Carcinoma of the Pancreas

TypeinterventionalSponsorUniversity of FloridaRan2009 to 2017Enrolled8ConditionsPancreatic CancerArmsProton radiation and chemotherapy
3 · Its place in the literature

Who cites it

185 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Pooled it
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  7. Pancreatic cancer.BMJ clinical evidence · 2010
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  9. Guideline
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  15. A reappraisal of preoperative chemoradiation for localized pancreatic head ductal adenocarcinoma in a 5-year single-institution experience.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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125 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

24 authors.

J P NeoptolemosDepartment of Surgery, Liverpool University, 5th Floor UCD Building, Daulby Street, Liverpool, L69 3GA, United Kingdom. j.p.neoptolemos@liverpool.ac.uk
D D Stocken
J A Dunn
J Almond
H G Beger
P Pederzoli
C Bassi
C Dervenis
L Fernandez-Cruz
F Lacaine
J Buckels
M Deakin
F A Adab
R Sutton
C Imrie
I Ihse
T Tihanyi
A Olah
S Pedrazzoli
D Spooner
D J Kerr
H Friess
M W Büchler
European Study Group for Pancreatic Cancer

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the influence of resection margins on survival for patients with resected pancreatic cancer treated within the context of the adjuvant European Study Group for Pancreatic Cancer-1 (ESPAC-1) study. SUMMARY BACKGROUND DATA: Pancreatic cancer is associated with a poor long-term survival rate of only 10% to 15% after resection. Patients with positive microscopic resection margins (R1) have a worse survival, but it is not known how they fare in adjuvant studies.

methodsESPAC-1, the largest randomized adjuvant study of resectable pancreatic cancer ever performed, set out to look at the roles of chemoradiation and chemotherapy. Randomization was stratified prospectively by resection margin status.

resultsOf 541 patients with a median follow-up of 10 months, 101 (19%) had R1 resections. Resection margin status was confirmed as an influential prognostic factor, with a median survival of 10.9 months for R1 versus 16.9 months months for patients with R0 margins. Resection margin status remained an independent factor in a Cox proportional hazards model only in the absence of tumor grade and nodal status. There was a survival benefit for chemotherapy but not chemoradiation, irrespective of R0/R1 status. The median survival was 19.7 months with chemotherapy versus 14.0 months without. For patients with R0 margins, chemotherapy produced longer survival compared with to no chemotherapy. This difference was less apparent for the smaller subgroup of R1 patients, but there was no significant heterogeneity between the R0 and R1 groups.

conclusionsResection margin-positive pancreatic tumors represent a biologically more aggressive cancer; these patients benefit from resection and adjuvant chemotherapy but not chemoradiation. The magnitude of benefit for chemotherapy treatment is reduced for patients with R1 margins versus those with R0 margins. Patients with R1 tumors should be included in future trials of adjuvant treatments and randomization and analysis should be stratified by this significant prognostic factor.

Indexed as

PancreatectomyAdenocarcinomaAgedAntineoplastic AgentsChemotherapy, AdjuvantFemaleHumansMaleMiddle AgedPancreasPancreatic NeoplasmsPrognosisProportional Hazards ModelsQuality of LifeRadiotherapy, AdjuvantSurvival RateAntineoplastic Agents

Identifiers

PMID11729382
PMCPMC1422135

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