Abstract:
BACKGROUND:Pancreatic cancer has an extremely poor prognosis and prolonged survival is achieved only by resection with macroscopic tumor clearance. There is a strong rationale for a neoadjuvant approach, since a relevant percentage of pancreatic cancer patients present with non-metastatic but locally advanced disease and microscopic incomplete resections are common. The objective of the present analysis was to systematically review studies concerning the effects of neoadjuvant therapy on tumor response, toxicity, resection, and survival percentages in pancreatic cancer. METHODS AND FINDINGS:Trials were identified by searching MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1966 to December 2009 as well as through reference lists of articles and proceedings of major meetings. Retrospective and prospective studies analyzing neoadjuvant radiochemotherapy, radiotherapy, or chemotherapy of pancreatic cancer patients, followed by re-staging, and surgical exploration/resection were included. Two reviewers independently extracted data and assessed study quality. Pooled relative risks and 95% confidence intervals were calculated using random-effects models. Primary outcome measures were proportions of tumor response categories and percentages of exploration and resection. A total of 111 studies (n = 4,394) including 56 phase I-II trials were analyzed. A median of 31 (interquartile range [IQR] 19-46) patients per study were included. Studies were subdivided into surveys considering initially resectable tumors (group 1) and initially non-resectable (borderline resectable/unresectable) tumors (group 2). Neoadjuvant chemotherapy was given in 96.4% of the studies with the main agents gemcitabine, 5-FU (and oral analogues), mitomycin C, and platinum compounds. Neoadjuvant radiotherapy was applied in 93.7% of the studies with doses ranging from 24 to 63 Gy. Averaged complete/partial response probabilities were 3.6% (95% CI 2%-5.5%)/30.6% (95% CI 20.7%-41.4%) and 4.8% (95% CI 3.5%-6.4%)/30.2% (95% CI 24.5%-36.3%) for groups 1 and 2, respectively; whereas progressive disease fraction was estimated to 20.9% (95% CI 16.9%-25.3%) and 20.8% (95% CI 14.5%-27.8%). In group 1, resectability was estimated to 73.6% (95% CI 65.9%-80.6%) compared to 33.2% (95% CI 25.8%-41.1%) in group 2. Higher resection-associated morbidity and mortality rates were observed in group 2 versus group 1 (26.7%, 95% CI 20.7%-33.3% versus 39.1%, 95% CI 29.5%-49.1%; and 3.9%, 95% CI 2.2%-6% versus 7.1%, 95% CI 5.1%-9.5%). Combination chemotherapies resulted in higher estimated response and resection probabilities for patients with initially non-resectable tumors ("non-resectable tumor patients") compared to monotherapy. Estimated median survival following resection was 23.3 (range 12-54) mo for group 1 and 20.5 (range 9-62) mo for group 2 patients. CONCLUSIONS:In patients with initially resectable tumors ("resectable tumor patients"), resection frequencies and survival after neoadjuvant therapy are similar to those of patients with primarily resected tumors and adjuvant therapy. Approximately one-third of initially staged non-resectable tumor patients would be expected to have resectable tumors following neoadjuvant therapy, with comparable survival as initially resectable tumor patients. Thus, patients with locally non-resectable tumors should be included in neoadjuvant protocols and subsequently re-evaluated for resection.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Gillen S,Schuster T,Meyer Zum Büschenfelde C,Friess H,Kleeff Jdoi
10.1371/journal.pmed.1000267subject
Has Abstractpub_date
2010-04-20 00:00:00pages
e1000267issue
4eissn
1549-1277issn
1549-1676journal_volume
7pub_type
杂志文章,meta分析,评审相关文献
PLOS MEDICINE文献大全abstract:BACKGROUND:The vast majority of medical interventions introduced into clinical development prove unsafe or ineffective. One prominent explanation for the dismal success rate is flawed preclinical research. We conducted a systematic review of preclinical research guidelines and organized recommendations according to the...
journal_title:PLoS medicine
pub_type: 杂志文章,评审
doi:10.1371/journal.pmed.1001489
更新日期:2013-01-01 00:00:00
abstract::Nathan Ford and Gottfried Hirnschall reflect on recent research by Jan Hontelez and colleagues published in this week's PLOS Medicine. The authors argue that the future HIV modeling efforts should focus on helping programs make choices about which interventions need to be prioritized in order to achieve the levels of ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1001535
更新日期:2013-10-01 00:00:00
abstract::[This corrects the article DOI: 10.1371/journal.pmed.1003293.]. ...
journal_title:PLoS medicine
pub_type: 已发布勘误
doi:10.1371/journal.pmed.1003517
更新日期:2020-12-29 00:00:00
abstract:BACKGROUND:As the number of HIV-infected women initiating lifelong antiretroviral therapy (ART) during pregnancy increases globally, concerns have emerged regarding low levels of retention in HIV services and suboptimal adherence to ART during the postpartum period. We examined the impact of integrating postpartum ART ...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1002547
更新日期:2018-03-30 00:00:00
abstract::A major challenge in monitoring universal health coverage (UHC) is identifying an indicator that can adequately capture the multiple components underlying the UHC initiative. Effective coverage, which unites individual and intervention characteristics into a single metric, offers a direct and flexible means to measure...
journal_title:PLoS medicine
pub_type: 杂志文章,评审
doi:10.1371/journal.pmed.1001730
更新日期:2014-09-22 00:00:00
abstract:BACKGROUND:The contribution of low-penetrant susceptibility variants to cancer is not clear. With the aim of searching for genetic factors that contribute to cancer at one or more sites in the body, we have analyzed familial aggregation of cancer in extended families based on all cancer cases diagnosed in Iceland over ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0010065
更新日期:2004-12-01 00:00:00
abstract:BACKGROUND:Nutritional supplements may improve development of infants born small (preterm or small for gestational age [SGA]) but may increase the risk of later metabolic disease. We conducted a systematic review and meta-analysis to assess the effects of macronutrient supplements for infants born small on later develo...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1002952
更新日期:2019-10-30 00:00:00
abstract::Is it ethical for scientists to conduct or to benefit from research in another country if that research would be unlawful, or not generally accepted, in their own country? ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040010
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Quantitative estimation of the extent to which the immune system's protective effect against one herpes simplex virus type 2 (HSV-2) infection protects against infection with additional HSV-2 strains is important for understanding the potential for HSV-2 vaccine development. Using viral genotyping, we estima...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002475
更新日期:2017-12-27 00:00:00
abstract:BACKGROUND:Standardised packaging (SP) of tobacco products is an innovative tobacco control measure opposed by transnational tobacco companies (TTCs) whose responses to the UK government's public consultation on SP argued that evidence was inadequate to support implementing the measure. The government's initial decisio...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001629
更新日期:2014-03-25 00:00:00
abstract:BACKGROUND:Type 2 diabetes (T2D) is a progressive disease whereby there is often deterioration in glucose control despite escalation in treatment. There is significant heterogeneity to this progression of glycemia after onset of diabetes, yet the factors that influence glycemic progression are not well understood. Give...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003209
更新日期:2020-07-28 00:00:00
abstract::This month in PLOS Medicine we launched a Special Issue on New Tools and Strategies for Tuberculosis Diagnosis, Care, and Elimination. In this issue's Editorial, the Guest Editors Claudia Denkinger, Richard Chaisson, and Mark Hatherill highlight some of the research that will publish and how these studies focusing on ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1002795
更新日期:2019-04-30 00:00:00
abstract:BACKGROUND:The SARS outbreak of 2002-2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. The World Health Organization (WHO) expert panel on SARS treatment requested a systematic review and comprehensive s...
journal_title:PLoS medicine
pub_type: 杂志文章,评审
doi:10.1371/journal.pmed.0030343
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of avail...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000241
更新日期:2010-03-02 00:00:00
abstract:BACKGROUND:Randomized clinical trials of oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention have widely divergent efficacy estimates, ranging from 0% to 75%. These discrepancies are likely due to differences in adherence. To our knowledge, no studies to date have examined the impact of improving adh...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001511
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:It has been suggested throughout the past fifty years that serum uric acid concentrations can help predict the future risk of coronary heart disease (CHD), but the epidemiological evidence is uncertain. METHODS AND FINDINGS:We report a "nested" case-control comparison within a prospective study in Reykjavik...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.0020076
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Many mathematical models have investigated the impact of expanding access to antiretroviral therapy (ART) on new HIV infections. Comparing results and conclusions across models is challenging because models have addressed slightly different questions and have reported different outcome metrics. This study co...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001245
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Care advances in the United States (US) have led to improved survival of children with neurological impairment (NI). Children with NI may account for an increasing proportion of hospital resources. However, this assumption has not been tested at a national level. METHODS AND FINDINGS:We conducted a study of...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001158
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:trans-fatty acids (TFAs) are a well-known risk factor of ischemic heart disease (IHD). In Australia, the highest TFA intake is concentrated to the most socioeconomically disadvantaged groups. Elimination of industrial TFA (iTFA) from the Australian food supply could result in reduced IHD mortality and morbid...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003407
更新日期:2020-11-02 00:00:00
abstract:BACKGROUND:To explore the possibility that antibody-mediated complement lysis contributes to viremia control in HIV-1 infection, we measured the activity of patient plasma in mediating complement lysis of autologous primary virus. METHODS AND FINDINGS:Sera from two groups of patients-25 with acute HIV-1 infection and ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030441
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. METHODS AND FINDINGS:We perf...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001670
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050125
更新日期:2008-06-17 00:00:00
abstract:BACKGROUND:Effective strategies are needed for the prevention of mother-to-child HIV transmission (PMTCT) in resource-limited settings. The Kisumu Breastfeeding Study was a single-arm open label trial conducted between July 2003 and February 2009. The overall aim was to investigate whether a maternal triple-antiretrovi...
journal_title:PLoS medicine
pub_type: 临床试验,杂志文章
doi:10.1371/journal.pmed.1001015
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Experimental and observational research has suggested the potential for increased type 2 diabetes (T2D) risk among populations taking statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, few studies have directly compared statin-associated benefits and harms or exami...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003280
更新日期:2020-08-26 00:00:00
abstract:BACKGROUND:Published research on prescribed opioid analgesic (POA) use during pregnancy and birth outcomes is limited in scope and has not adequately adjusted for potential confounding factors. To help address these gaps, we estimated associations between maternal POAs during pregnancy and two adverse birth outcomes us...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002980
更新日期:2019-12-02 00:00:00
abstract:BACKGROUND:There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVI...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003379
更新日期:2020-09-22 00:00:00
abstract:BACKGROUND:Unrecognized myocardial infarction (UMI) is known to constitute a substantial portion of potentially lethal coronary heart disease. However, the diagnosis of UMI is based on the appearance of incidental Q-waves on 12-lead electrocardiography. Thus, the syndrome of non-Q-wave UMI has not been investigated. De...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000057
更新日期:2009-04-21 00:00:00
abstract:BACKGROUND:Global warming is predicted to indirectly result in more undernutrition by threatening crop production. Whether temperature rise could affect undernutrition directly is unknown. We aim to quantify the relationship between short-term heat exposure and risk of hospitalization due to undernutrition in Brazil. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002950
更新日期:2019-10-29 00:00:00
abstract:BACKGROUND:The proteases (secretases) that cleave amyloid-beta (Abeta) peptide from the amyloid precursor protein (APP) have been the focus of considerable investigation in the development of treatments for Alzheimer disease. The prediction has been that reducing Abeta production in the brain, even after the onset of c...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0020355
更新日期:2005-12-01 00:00:00
abstract::Kwonjune Seung and colleagues describe the Eugene Bell Foundation's experience of treating MDR-TB in North Korea. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002062
更新日期:2016-08-02 00:00:00