Abstract
The real impact of specific sites of metastasis on prognosis of metastatic pancreatic cancer (MPC) is unknown. To evaluate the association of specific metastatic sites and survival outcomes in MPC a systematic literature review was performed including prospective randomized trials of systemic treatments in metastatic pancreatic cancer indexed in PubMed, Embase and Web of Science. Data regarding systemic treatment regimens, progression free survival and overall survival were extracted. The outcomes were compared using a random effects model. The index I2 and the graphs of funnel plot were used for the interpretation of the data. Of 1,052 abstracts, 7 randomized trials were considered eligible with a combined sample size of 2,975 MPC patients. Combining the studies with meta-analysis, we could see that patients with liver metastasis had a HR for death of 1.53 with 95% CI of 1.15 to 2.02 (p-value 0.003) and HR for risk of progression of 1.96 with 95% CI of 1.28 to 2.99 (p-value 0.002), without significant heterogeneity. Having two or more sites of metastasis comparing to one site did not have impact on overall survival; RR of 1.05 with 95% CI 0.91 to 1.23 (p-value 0.493). In conclusion, liver metastasis confers worse outcomes among patients with MPC. Apparently, multiple metastatic sites do not present worse prognosis when compared with only one organ involved, therefore, demonstrating the severity of this disease. Prospective studies evaluating other treatments are necessary to address the impact of local treatments in liver metastasis in MPC.
Highlights
Pancreatic cancer (PC) is a deadly cancer, being among the five most lethal malignant tumors in the last years [1]
For meta-analysis we considered articles that met the inclusion criteria and presented a hazard ratio (HR) followed by standard errors / confidence intervals or medians of survival of the groups accompanied by the number of events in each group
These results suggested that number of different metastasis sites have no impact on the overall survival outcome for patient with metastatic pancreatic cancer
Summary
Pancreatic cancer (PC) is a deadly cancer, being among the five most lethal malignant tumors in the last years [1]. Most patients are diagnosed with advanced disease and few survival gains were obtained in the past decades [2]. Efforts have been made to obtain better outcomes. Numerous studies have described molecular advances to improve and develop guided therapies [3,4,5]. The applicability of molecular classifications in treatment decisions is still a topic to be evaluated [6].
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