Optimal adjuvant chemotherapy for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis

// Jian-Bo Xu 1 , Bin Jiang 1 , Ya Chen 1 , Fu-Zhen Qi 1 , Jian-Huai Zhang 1 and Hang Yuan 2 1 Department of Hepatobiliary Surgery, Huai’an First People’s Hospital, Nanjing Medical University, Nanjing, China 2 Department of Coloproctologic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, China Correspondence to: Hang Yuan, email: yuanhang1981@126.com Keywords: pancreatic cancer, surgery resection, adjuvant chemotherapy, toxic effect, network meta-analysis Received: January 09, 2017 Accepted: June 19, 2017 Published: July 07, 2017 ABSTRACT Adjuvant chemotherapy improves survival in patients with resected pancreatic cancer but the optimal regimen remains unclear. We aim to compare all possible adjuvant chemotherapy in terms of overall survival and toxic effects. Pubmed, Trial registries and Cochrane library databases for randomized controlled trials were searched until November 2016. Thirteen trials were included for network analysis and the hazard ratios (HRs) for survival and odds ratios for toxic effects were assessed via Aggregate Data Drug Information System software. Only S-1 chemotherapy improved 1-year, 3-year and 5-year survival compared with observation (HR (95% CI): 3.94 (1.18–12.34); 4.08 (1.58–8.24) and 5.09 (1.16–29.83) respectively). Although not significant, gemcitabine plus uracil/tegafur was associated with poorer 1-year and 3-year survival compared with observation (HR (95% CI): 0.85 (0.16–4.03) and 0.86 (0.23–2.95)). Adding radiation to chemotherapy has no significant improvement in survival. S-1 and gemcitabine plus capecitabine are currently the most effective adjuvant therapies for pancreatic cancer. While S1 has only been validated in Asian people, higher toxicity is an issue for gemcitabine plus capecitabine.