Evidence map›Paper›PMID 34027585›Full record

ArticleAnnals of surgical oncology2021

Impact of Neoadjuvant Therapy on Survival Following Margin-Positive Resection for Pancreatic Cancer.

Asmita Chopra, Mazen Zenati, Melissa E Hogg, Herbert J Zeh, David L Bartlett, Nathan Bahary, Amer H Zureikat, Joal D Beane

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Article in Annals of surgical oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Asmita ChopraDepartment of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Mazen ZenatiDepartment of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Melissa E HoggDepartment of Surgery, North Shore Hospital, Chicago, IL, USA.
Herbert J ZehDepartment of Surgery, University of Texas Southwestern, Dallas, TX, USA.
David L BartlettDepartment of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Nathan BaharyDepartment of Medical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Amer H ZureikatDepartment of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Joal D BeaneDepartment of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. joaldbeane@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionA positive microscopic margin (R1) following resection of pancreatic ductal adenocarcinoma (PDAC) can occur in up to 80% of patients and is associated with reduced survival and increased recurrence. Our aim was to characterize the impact of neoadjuvant therapy (NAT) on survival and recurrence in patients with PDAC following an R1 resection.

methodsA retrospective analysis of patients with PDAC who underwent pancreatectomy from 2008 to 2017 was performed. Patients were staged according to the American Joint Committee on Cancer 8th edition and stratified based on resection margin (R0 vs. R1) and treatment sequence (NAT vs. surgery first [SF]). Conditional survival analysis was performed using Cox regression and inverse probability weighted estimates.

resultsAmong 580 patients, 59% received NAT and 41% underwent SF. On final pathology, the NAT cohort had smaller tumors and less lymph node (LN) positivity (p < 0.05). NAT was not associated with an R1 resection (50%, p = 0.653). Compared with the R1 cohort, the R0 cohort had a higher median overall survival (OS; 39.6 vs. 22.8 months; hazard ratio [HR] 1.6, p < 0.001) and disease-free survival (DFS; 19 vs. 13 months; HR 1.35, p = 0.004). After risk adjustment, NAT was not associated with OS, regardless of margin status (R0, 95% confidence interval [CI] (-)7.31-27.07, p = 0.26; or R1, 95% CI (-)36.99-15.25, p = 0.42). However, NAT was associated with improved DFS in the R1 cohort (95% CI 1.79-11.91, p = 0.008) but not in the R0 cohort (95% CI (-)11.22-10.54, p = 0.95).

conclusionAn R0 resection remains an important determinant of overall and disease-free survival, even when NAT is administered. For patients with an R1 resection, receipt of NAT may prolong DFS.

Indexed as

Carcinoma, Pancreatic DuctalPancreatic NeoplasmsHumansNeoadjuvant TherapyNeoplasm Recurrence, LocalRetrospective StudiesSurvival Rate

Identifiers

PMID34027585

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.