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Preoperative inflammatory scores are not helpful to predict early recurrence in pancreatic ductal adenocarcinoma after resection : a systematic review and metaanalysis
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Contexto: Mais de 50% dos pacientes submetidos a ressecção cirúrgica de Adenocarcinoma Ductal Pancreático (PDAC) apresentam recorrência nos primeiros 12 meses após a cirurgia. Objetivo: A presente revisão sistemática e meta-análise tem como objetivo avaliar a capacidade discriminatória de scores inflamatórios pré-operatórios na previsão de recorrência precoce após ressecção cirúrgica e, assim, identificar os melhores candidatos para a realização da mesma. Métodos: As bases de dados Medline e Web of Science foram utilizadas na pesquisa de estudos que relatassem o papel dos scores inflamatórios nos resultados oncológicos do PDAC após cirurgia com intenção curativa. Esta revisão sistemática permitiu determinar os scores inflamatórios mais comumente utilizados a serem incluídos na meta-análise. Esta última concentrou-se em avaliar o valor prognóstico dos vários scores, nomeadamente Modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI), Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR) e Systemic Immune-Inflammation Index (SSI), na previsão de recorrência precoce (dentro de 12 meses) após ressecção cirúrgica. Adicionalmente, foi realizada uma análise de subgrupo para diferenciar os resultados entre pacientes submetidos à cirurgia como tratamento inicial e aqueles que passaram por quimioterapia neoadjuvante. O risco de viés nos estudos incluídos foi avaliado usando a ferramenta ROBINS-I. Resultados: Foram identificados 1864 artigos, dos quais 16 cumpriam aos critérios de elegibilidade para análise. Os estudos incluídos abrangeram um total de 4460 pacientes. Nove estudos relataram resultados para mGPS, quatro estudos para PNI, sete estudos para PLR, oito estudos para NLR e dois estudos para SSI. Na meta-análise, mGPS, NLR e PLR apresentaram taxas significativamente mais altas de recorrência precoce nos grupos de scores altos em comparação com os grupos de scores baixos. Uma análise da sensibilidade e especificidade desses scores não mostrou diferença significativa na sua acuidade diagnóstica (mGPS - AUC=0.534; NLR - AUC=0.628; e PLR – AUC=0.607). PNI e SSI demonstraram taxas semelhantes de recorrência precoce entre ambos os grupos. Conclusão: Os scores inflamatórios mGPS, PNI, PLR, NLR e SII não apresentaram uma acuidade diagnóstica suficiente para prever recorrência precoce após a ressecção cirúrgica do PDAC. Consequentemente, quando utilizados como fatores isolados, esses scores inflamatórios não são ferramentas úteis para selecionar candidatos ideais ou descartar uma possível indicação cirúrgica.
Background: In patients undergoing surgical resection for Pancreatic Ductal Adenocarcinoma (PDAC), more than 50% experience recurrence within the initial 12 months after surgery. Objective: The aim of the current systematic review and meta-analysis is to evaluate the discriminatory ability of preoperative inflammatory scores in predicting early recurrence after resection and, hence, to identify the best candidates for surgical resection. Methods: Medline and Web of Science databases were searched for studies reporting the role of inflammatory scores on oncological outcomes of PDAC after curative-intent surgery. We used this systematic review to determine the most commonly used scores to include in meta-analysis. The meta-analysis focused on evaluating the prognostic value of various scores, namely modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI), Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), and Systemic Immune-Inflammation Index (SSI), in predicting early recurrence (within 12 months) after resection. Additionally, a subgroup analysis was conducted to differentiate outcomes between patients undergoing upfront surgery and those who underwent neoadjuvant chemotherapy. The risk of bias in the included studies was assessed using the ROBINS-I tool. Results: The literature search identified 1864 articles, with 16 meeting the eligibility criteria for analysis. The included studies encompassed a total of 4460 patients. 9 studies reported outcomes for mGPS, 4 studies for PNI, 7 studies for PLR, 8 studies for NLR, and 2 studies for SSI. In the meta-analysis, mGPS, NLR, and PLR showed significantly higher rates of early recurrence in the high-score groups compared to the low-score groups. An analysis of the sensitivity and specificity of these scores showed no significant difference in their diagnostic accuracy (mGPS - AUC=0.534; NLR - AUC=0.628; and PLR –AUC=0.607). PNI and SSI demonstrated similar rates of early recurrence between high and low-score groups. Conclusion: mGPS, PNI, PLR, NLR, and SII did not show a sufficient diagnostic accuracy to predict early recurrence after the resection of PDAC. Consequently, when used as single factors, these inflammatory scores are not helpful tools for selecting optimal candidates or ruling out a potential surgical indication.
Background: In patients undergoing surgical resection for Pancreatic Ductal Adenocarcinoma (PDAC), more than 50% experience recurrence within the initial 12 months after surgery. Objective: The aim of the current systematic review and meta-analysis is to evaluate the discriminatory ability of preoperative inflammatory scores in predicting early recurrence after resection and, hence, to identify the best candidates for surgical resection. Methods: Medline and Web of Science databases were searched for studies reporting the role of inflammatory scores on oncological outcomes of PDAC after curative-intent surgery. We used this systematic review to determine the most commonly used scores to include in meta-analysis. The meta-analysis focused on evaluating the prognostic value of various scores, namely modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI), Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), and Systemic Immune-Inflammation Index (SSI), in predicting early recurrence (within 12 months) after resection. Additionally, a subgroup analysis was conducted to differentiate outcomes between patients undergoing upfront surgery and those who underwent neoadjuvant chemotherapy. The risk of bias in the included studies was assessed using the ROBINS-I tool. Results: The literature search identified 1864 articles, with 16 meeting the eligibility criteria for analysis. The included studies encompassed a total of 4460 patients. 9 studies reported outcomes for mGPS, 4 studies for PNI, 7 studies for PLR, 8 studies for NLR, and 2 studies for SSI. In the meta-analysis, mGPS, NLR, and PLR showed significantly higher rates of early recurrence in the high-score groups compared to the low-score groups. An analysis of the sensitivity and specificity of these scores showed no significant difference in their diagnostic accuracy (mGPS - AUC=0.534; NLR - AUC=0.628; and PLR –AUC=0.607). PNI and SSI demonstrated similar rates of early recurrence between high and low-score groups. Conclusion: mGPS, PNI, PLR, NLR, and SII did not show a sufficient diagnostic accuracy to predict early recurrence after the resection of PDAC. Consequently, when used as single factors, these inflammatory scores are not helpful tools for selecting optimal candidates or ruling out a potential surgical indication.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Carcinoma pancreático Recorrência Cirurgia pancreática