188P The impact of sarcopenia on chemotherapy toxicity and survival rate among pancreatic cancer patients who underwent chemotherapy: A systematic review and meta-analysis

Abstract Background Surgical resection remains the only curative treatment for pancreatic cancer and is associated with significant post-operative morbidity and mortality. Patients eligible for surgery, increasingly receive neo-adjuvant therapy before surgery or adjuvant therapy afterward, inherently exposing them to toxicity. As such, optimizing physical function through exercise during treatment remains imperative to optimize quality of life either before surgery or during rehabilitation. However, current exercise efficacy and prescription in pancreatic cancer is unknown. Therefore, this study aims to summarise the published literature on exercise studies conducted in patients with pancreatic cancer undergoing treatment with a focus on determining the current prescription and progression patterns being used in this population. Methods A systematic review of four databases identified studies evaluating the effects of exercise on aerobic fitness, muscle strength, physical function, body composition, fatigue and quality of life in participants with pancreatic cancer undergoing treatment, published up to 24 July 2020. Two reviewers independently reviewed and appraised the methodological quality of each study. Results Twelve studies with a total of 300 participants were included. Heterogeneity of the literature prevented meta-analysis. Exercise was associated with improvements in outcomes; however, study quality was variable with the majority of studies receiving a weak rating. Conclusions High quality evidence regarding the efficacy and prescription of exercise in pancreatic cancer is lacking. Well-designed trials, which have received feedback and input from key stakeholders prior to implementation, are required to examine the impact of exercise in pancreatic cancer on key cancer related health outcomes.

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The Effect of Celiac Neurolysis and Splanchnicectomy on Survival in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Digestive Surgery ◽

10.1159/000520456 ◽

2021 ◽

pp. 1-9

Author(s):

Linhan Ye ◽

Stephan Schorn ◽

Ilaria Pergolini ◽

Okan Safak ◽

Elke Demir ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Fixed Effects ◽

Meta Analysis ◽

Stage Iv ◽

Stage Iii ◽

Cochrane Library ◽

Unresectable Pancreatic Cancer ◽

Relevant Effect ◽

The Impact

Background: Intractable pancreatic pain is one of the most common symptoms of patients with pancreatic ductal adenocarcinoma (PDAC). Celiac neurolysis (CN) and splanchnicectomy were already described as effective methods to manage abdominal pain in unresectable PDAC, but their impact on overall survival (OS) has not yet been established. Objective: We aimed to investigate the impact of CN and splanchnicectomy on the survival of patients with unresectable pancreatic cancer. Methods: A systematic review of PubMed and Cochrane Library according to predefined searching terms was conducted in March 2020. Hazard ratios (HR) of OS data were calculated using the Mantel-Haenszel model for random effects or fixed effects. Result: Four randomized-controlled trials (RCTs) and 2 non-RCTs with a total of 2,507 patients were identified. The overall pooled HR did not reveal any relevant effect of CN and splanchnicectomy on OS (HR: 1.03; 95% CI: 0.81–1.32), which was also underlined by the sensitivity analysis of RCTs (HR: 1.0; 95% CI: 0.72–1.39) and non-RCTs (HR: 1.07; 95% CI: 0.71–1.63). However, subgroup analyses depending on tumor stage revealed that CN or splanchnicectomy was associated with a worsened OS in AJCC (American Joint Committee on Cancer) stage III patients with unresectable PDAC (HR: 1.22; 95% CI: 1.03–1.45), but nor for AJCC stage IV patients (HR: 1.27; 95% CI: 0.9–1.80). Conclusion: Although only few data are currently available, this systematic review with meta-analysis showed that in unresectable PDAC, CN or splanchnicectomy is associated with a worsened survival in stage III PDAC patients, with no effect on stage IV PDAC patients. These data call for caution in the usage of CN or splanchnicectomy in stage III PDAC and for further studies addressing this observation.

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Systematic review of histamine type 2 receptor antagonists as an adjunct to curative surgical resection in gastrointestinal malignancies

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15085 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15085-e15085

Author(s):

S. Deva ◽

M. B. Jameson

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Surgical Resection ◽

Risk Ratio ◽

Meta Analysis ◽

Tumor Infiltrating Lymphocytes ◽

Cochrane Collaboration ◽

Curative Intent ◽

Gastrointestinal Malignancies ◽

The Impact

e15085 Background: H2RAs have induced regression in a number of malignancies. The mechanisms that may contribute to this effect include inhibition of T-suppressor lymphocytes, increased tumor infiltrating lymphocytes and blockade of histamine-induced tumor proliferation and angiogenesis. Unique to cimetidine is its ability to inhibit vascular endothelial expression of the cell adhesion molecule E-selectin, to which many GI tumor cells adhere via carbohydrate antigen ligands. The optimal use of H2RAs in cancer patients could therefore be as adjuvant therapy rather than for metastatic disease. Methods: This systematic review examines the impact of H2RAs on the overall survival of patients when used as an adjunct to curative surgical resection for a GI malignancy. Using a sensitive search strategy, randomized controlled trials were identified in relevant databases. Criteria for study selection included: patients with colorectal or gastric cancer surgically resected with curative intent; H2RAs used i) at any dose, ii) for any length of time, iii) with any other treatment modality and iv) in the pre-, peri- or post-operative period. The results were stratified for both the type of malignancy and the H2RA used and analyzed by meta-analysis using Cochrane Collaboration software. Results: Of 350 trials identified, 8 were eligible for inclusion and had sufficient data for analysis, including a total of 1461 patients. Meta-analysis revealed a risk ratio for mortality of 0.86 (95% CI 0.76–0.99, p = 0.03) for patients randomised to H2RAs. Trials of colorectal cancer patients where cimetidine was the H2RA being evaluated demonstrated a significant survival advantage, risk ratio 0.53 (95% CI 0.33–0.84, p = 0.007). All other subgroups demonstrated a non-significant trend favouring H2RAs. Conclusions: H2RAs, and cimetidine in particular, appear to confer a survival benefit when given as an adjunct to curative surgical resection of GI cancers. The trial designs were heterogeneous and further large studies are warranted. No significant financial relationships to disclose.

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Predictive role of skin rash in advanced pancreatic cancer patients treated with gemcitabine plus erlotinib: a systematic review and meta-analysis

OncoTargets and Therapy ◽

10.2147/ott.s168418 ◽

2018 ◽

Vol Volume 11 ◽

pp. 6633-6646

Author(s):

Minyan Zeng ◽

Qi Feng ◽

Ming Lu ◽

Jun Zhou ◽

Zuyao Yang ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Cancer Patients ◽

Skin Rash ◽

Meta Analysis ◽

Advanced Pancreatic Cancer ◽

Predictive Role

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The Impact of ABO Blood Type on Developing Venous Thromboembolism in Cancer Patients: Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10163692 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3692

Author(s):

Fumihiko Urabe ◽

Shoji Kimura ◽

Kosuke Iwatani ◽

Keiji Yasue ◽

Yuhei Koike ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Meta Analysis ◽

Multivariate Logistic Regression Analysis ◽

Blood Type ◽

Pelvic Surgery ◽

Cochrane Library ◽

Abo Blood Type ◽

The Impact

The impact of ABO blood type in the development of venous thromboembolism in cancer patients remains controversial. To develop a sense of the current opinion in this area, we conducted a systematic review and meta-analysis. In March 2021, we performed a systematic search of PubMed, the Cochrane library, and Scopus for studies that compared cancer patients who had a blood type of either O or non-O (A, B, and AB). Our objective was to use multivariate logistic regression analysis to determine how ABO blood type was associated with the development of venous thromboembolism. Our selection criteria were met by a total of nine studies in 25,884 patients for the systematic review and five studies in 22,777 patients for the meta-analysis. In cancer patients, we found that non-O blood type was associated with a nearly two-fold increase in risk of venous thromboembolism (pooled OR: 1.74, 95% CI: 1.44–2.10). Additionally, among the eligible patients, 21,889 patients were post-operative urological cancer patients. In these patients, the analysis also showed an association between non-O blood type and increasing risk of venous thromboembolism after pelvic surgery for malignancy (pooled OR: 1.73, 95% CI: 1.36–2.20). Our meta-analysis suggested that non-O blood type is a risk factor for venous thromboembolism among patients with cancer. As blood type is routinely determined preoperatively by objective and standardized methods, we anticipate that our results will be useful for managing venous thromboembolism in cancer patients, especially after pelvic surgery for urological cancers.

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Statins Use and Overall Survival in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis

Gastroenterology ◽

10.1016/s0016-5085(17)31225-8 ◽

2017 ◽

Vol 152 (5) ◽

pp. S277-S278

Author(s):

Srikar R. Mapakshi ◽

Jennifer R. Kramer ◽

Kathryn E. Royse ◽

Elizabeth Chiao ◽

Jose M. Garcia ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Meta Analysis

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Primary Thromboprophylaxis in Ambulatory Pancreatic Cancer Patients Receiving Chemotherapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽

10.3390/cancers12082028 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2028 ◽

Cited By ~ 1

Author(s):

Corinne Frere ◽

Benjamin Crichi ◽

Barbara Bournet ◽

Cindy Canivet ◽

Nassim Ait Abdallah ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Cancer Patients ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Phase Iii ◽

Number Needed To Treat ◽

Randomized Controlled ◽

Randomized Controlled Studies

Patients with pancreatic cancer (PC) carry the highest risk of venous thromboembolism (VTE) amongst all cancer patients. Appropriate use of primary thromboprophylaxis might significantly and safely reduce its burden. We performed a systematic review of published studies and meeting abstracts using MEDLINE and EMBASE through July 2020 to evaluate the efficacy and safety of primary thromboprophylaxis in ambulatory PC patients receiving chemotherapy. The Mantel–Haenszel random effect model was used to estimate the pooled event-based risk ratio (RR) and the pooled absolute risk difference (RD) with a 95% confidence interval (CI). Five randomized controlled studies with 1003 PC patients were included in this meta-analysis. Compared to placebo, thromboprophylaxis significantly decreased the risk of VTE (pooled RR 0.31, 95% CI 0.19–0.51, p < 0.00001, I2 = 8%; absolute RD −0.08, 95% CI −0.12–−0.05, p < 0.00001, I2 = 0%), with an estimated number needed to treat of 11.9 patients to prevent one VTE event. Similar reductions of VTE were observed in studies with parenteral (RR 0.30, 95% CI 0.17–0.53) versus oral anticoagulants (RR 0.37, 95% CI 0.14–0.99) and in studies using prophylactic doses of anticoagulants (RR 0.34, 95% CI 0.17–0.70) versus supra-prophylactic doses of anticoagulants (RR 0.27, 95% CI 0.08–0.90). The pooled RR for major bleeding was 1.08 (95% CI 0.47–2.52, p = 0.85, I2 = 0%) and the absolute RD was 0.00 (95% CI −0.02–0.03, p = 0.85, I2 = 0%). Evidence supports a net clinical benefit of thromboprophylaxis in ambulatory PC patients receiving chemotherapy. Adequately powered randomized phase III studies assessing the most effective anticoagulant and the optimal dose, schedule and duration of thromboprophylaxis to be used are warranted.

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