Title : Survival after irreversible electroporation in patients with unresectable locally advanced pancreatic ductal adenocarcinoma: A systematic review and meta-analysis with meta-regression of predictors
Abstract:
Aims: To evaluate the overall survival (OS) time and predictors of survival in patients with unresectable locally advanced pancreatic ductal adenocarcinoma (PDAC) who were treated with irreversible electroporation (IRE)
Methods: In compliance with PRISMA statement standards, a systematic review including random-effects single-arm meta-analysis, comparison meta-analysis, and meta-regression models was conducted. All studies reporting OS time after IRE in patients with unresectable locally advanced PDAC were included.
Results: Thirty-one studies including 1296 patients were included. The OS time after IRE was 16.3 months (95% CI 14.2-18.4); it was longer in patients who received IRE compared to those who did not (MD: 6.97 months, 95% CI 0.79-13.15, p=0.03). The OS time was not affected by age (coefficient: -0.088, p=0.722), male sex (coefficient: -0.049, p= 0.314), tumour size (coefficient: -0.049, p=0.710), tumours located in head of pancreas (coefficient: -3.141, p=0.696), tumours located in body or tail of pancreas (coefficient: 2.498, p=0.747), and pretreatment chemotherapy (coefficient: 3.378, p=0.233). Subgroup analyses showed that OS time was not affected by surgical (18.1 months, 95% CI 13.4-22.9) or percutaneous (14.9 months, 95% CI 12.2-17.6) approaches used or when IRE was combined with immunotherapy (20.3 months, 95% CI 5.4-35.2) or chemotherapy (18.5 months, 95% CI 15.5-21.4).
Conclusions: IRE may improve OS time by 6.97 months in patients with unresectable locally advanced PDAC (low-to-moderate certainty). The results of current study support the rationale for conducting future randomised trials in this setting and provide robust basis for hypothesis synthesis and power analysis
