Abstract
Abstract Aims To evaluate comparative outcomes of pancreatic cancer resection with or without adjuvant chemotherapy in patients with stage I pancreatic cancer. Methods A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies reporting outcomes of pancreatic cancer resection for stage I cancer with or without adjuvant chemotherapy were included and their risk of bias were assessed using ROBINS-I tool. Survival outcomes were analysed using hazard ratio (HR) and odds ratio (OR) for the time-to-event and dichotomous outcomes, respectively. Results We included 5 comparative studies reporting a total of 4,037 patients with resected stage 1 pancreatic cancer of whom 2,374 patients had no adjuvant chemotherapy and the remaining 1663 patients received adjuvant chemotherapy. The use of adjuvant chemotherapy was associated with significantly higher overall survival rate (HR 0.73, 95% CI 0.63-0.84, p<0.00001) compared to no use of adjuvant chemotherapy. However, there was no statistically significant difference in 1-year (81.9% versus 87.4%, OR 0.51, 95% CI 0.14-1.81, p=0.30), 2-year (60.9% versus 67.5%, OR 0.88, 95% CI 0.75-1.03, p=0.10), 3-year (51.8% versus 54.3%, OR 0.99, 95% CI 0.79-1.24, p=0.93), or 5-year survival (27.4% versus 27.5%, OR 1.11, 95% CI 0.95-1.30, p=0.19) between two groups. Conclusions Meta-analysis of best available evidence (level 2a) demonstrates that adjuvant chemotherapy following resected stage I pancreatic cancer seems to improve overall survival compared to no use of adjuvant chemotherapy. Randomised controlled trials are required to escalate the level of evidence and confirm these findings.
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