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Prognostic value of lymph node ratio in pancreatic ductal adenocarcinoma : a systematic review and meta-analysis
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Introdução: O adenocarcinoma ductal do pâncreas é umas das principais causas de mortalidade por cancro em todo o mundo, caracterizado por uma baixa taxa de sobrevivência aos 5 anos. O rácio de gânglios linfáticos (LNR) emerge como um potencial fator de prognóstico. Dada a sua importância em outros tipos de neoplasias, esta revisão sistemática e meta-análise tem como objetivo avaliar e sintetizar de forma abrangente a evidência existente sobre a eficácia do LNR no adenocarcinoma ductal do pâncreas.
Métodos: As bases de dados da Medline e Web of Science foram pesquisadas até fevereiro de 2023 para procurar estudos que avaliassem o impacto prognóstico do RGL em doentes com adenocarcinoma ductal do pâncreas. Forma incluídos estudos que fornecessem resultados de sobrevivência em função do LNR e que apresentassem descrições metodológicas claras. A extração de dados incidiu nas características do estudo, nos dados demográficos dos doentes, nos valores de LNR e nos dados de sobrevivência. A qualidade dos estudos incluídos foi avaliada utilizando a ferramenta ROBINS-I. A meta-análise foi realizada recorrendo a modelos de efeitos aleatórios para calcular as taxas de risco agrupadas para sobrevivência global e sobrevivência especifica do tumor, ajustando a heterogeneidade.
Resultados: A nossa pesquisa encontrou 2634 artigos, 15 dos quais elegíveis para análise. Os estudos incluídos englobavam um total de 44297 pessoas. 11 estudos relatavam o resultado de sobrevida global, 2 relatavam o resultado de sobrevida livre de doença e 5 estudos relataram sobrevivência a 5 anos. A nossa meta-análise mostrou que um LNR mais alto está associado a piores resultados de sobrevivência no adenocarcinoma ductal do pâncreas. Para a sobrevida global, um LNR mais alto estava associado a piores resultados para valores de LNR > 0,2 (HR = 1.65, 95% CI: 1.37-1.94, P < 0.00001, I² = 84%) e LNR > 0,4 (HR = 1.66, 95% CI: 1.10-2.52, P = 0.02, I² = 86%). De forma semelhante, um LNR mais alto associava-se a uma pior sobrevida livre de doença para LNR > 0,2 (HR = 1.76, 95% CI: 1.26-2.47, P = 0.001, I² = 42%) e LNR > 0,4 (HR = 1.84, 95% CI: 1.14-2.96, P = 0.01, I² = 54%). Na sobrevivência a 5 anos, um LNR inferior a 0,2 indicava melhores resultados (HR = 0.53, 95% CI: 0.38 – 0.74, P = 0.0002, I² = 0%).Conclusões: Parece haver um valor prognóstico significativo do LNR no adenocarcinoma ductal do pâncreas. Um LNR mais elevado associa-se a uma pior sobrevida global. Estudos no futuro deverão padronizar protocolos cirúrgicos e patológicos e realizar análises detalhadas de subgrupos para validar a utilidade prognóstica do LNR e melhorar os resultados dos doentes.
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer mortality globally, characterized by a dismal 5-year survival rate. The lymph node ratio (LNR) emerges as a potential prognostic marker. Given its established prognostic importance in other malignancies, this systematic review and meta-analysis aims to comprehensively assess and synthesize evidence on LNR's effectiveness in PDAC. Methods: Medline and Web of Science databases were searched up to February 2023 for studies that evaluated the prognostic impact of LNR in patients with pancreatic ductal adenocarcinoma. Inclusion criteria were studies that provided survival outcomes based on LNR and had clear methodological descriptions. Data extraction focused on study characteristics, patient demographics, LNR values, and survival data. The quality of the included studies was assessed using the ROBINS-I tool. Meta-analysis was performed using random-effects models to calculate pooled hazard ratios for outcomes retrieved, adjusting for heterogeneity. Results: The literature search retrieved 2634 articles, 15 of which were eligible for analysis. The included studies comprised 44297 people. 11 studies reported the outcome overall survival (OS), 2 reported the outcome of disease-free survival (DFS), and 5 reported 5-year survival. Our meta-analysis showed that higher LNR is associated with poorer survival outcomes in PDAC. For OS, higher LNR was linked to worse outcomes at thresholds of 0,2 (HR = 1.65, 95% CI: 1.37-1.94, P < 0.00001, I² = 84%) and 0,4 (HR = 1.66, 95% CI: 1.10-2.52, P = 0.02, I² = 86%). Similarly, higher LNR was associated with worse DFS at thresholds of 0,2 (HR = 1.76, 95% CI: 1.26-2.47, P = 0.001, I² = 42%) and 0,4 (HR = 1.84, 95% CI: 1.14-2.96, P = 0.01, I² = 54%). For 5-year survival, a LNR lower than 0,2 indicated a better outcome (HR = 0.53, 95% CI: 0.38 – 0.74, P = 0.0002, I² = 0%). Conclusions: There seems to be a significant prognostic value of the LNR in PDAC. A higher LNR correlates with poorer overall survival. Future research should standardize surgical and pathological protocols and conduct detailed subgroup analyses to validate LNR's prognostic utility and improve patient outcomes.
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer mortality globally, characterized by a dismal 5-year survival rate. The lymph node ratio (LNR) emerges as a potential prognostic marker. Given its established prognostic importance in other malignancies, this systematic review and meta-analysis aims to comprehensively assess and synthesize evidence on LNR's effectiveness in PDAC. Methods: Medline and Web of Science databases were searched up to February 2023 for studies that evaluated the prognostic impact of LNR in patients with pancreatic ductal adenocarcinoma. Inclusion criteria were studies that provided survival outcomes based on LNR and had clear methodological descriptions. Data extraction focused on study characteristics, patient demographics, LNR values, and survival data. The quality of the included studies was assessed using the ROBINS-I tool. Meta-analysis was performed using random-effects models to calculate pooled hazard ratios for outcomes retrieved, adjusting for heterogeneity. Results: The literature search retrieved 2634 articles, 15 of which were eligible for analysis. The included studies comprised 44297 people. 11 studies reported the outcome overall survival (OS), 2 reported the outcome of disease-free survival (DFS), and 5 reported 5-year survival. Our meta-analysis showed that higher LNR is associated with poorer survival outcomes in PDAC. For OS, higher LNR was linked to worse outcomes at thresholds of 0,2 (HR = 1.65, 95% CI: 1.37-1.94, P < 0.00001, I² = 84%) and 0,4 (HR = 1.66, 95% CI: 1.10-2.52, P = 0.02, I² = 86%). Similarly, higher LNR was associated with worse DFS at thresholds of 0,2 (HR = 1.76, 95% CI: 1.26-2.47, P = 0.001, I² = 42%) and 0,4 (HR = 1.84, 95% CI: 1.14-2.96, P = 0.01, I² = 54%). For 5-year survival, a LNR lower than 0,2 indicated a better outcome (HR = 0.53, 95% CI: 0.38 – 0.74, P = 0.0002, I² = 0%). Conclusions: There seems to be a significant prognostic value of the LNR in PDAC. A higher LNR correlates with poorer overall survival. Future research should standardize surgical and pathological protocols and conduct detailed subgroup analyses to validate LNR's prognostic utility and improve patient outcomes.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Adenocarcinoma ductal do pâncreas Rácio de gânglios linfáticos Valor prognóstico Revisão sistemática Meta-análise Pâncreas Neoplasias pancreáticas