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Table 1 Characteristics and quality assessment of the included studies

From: Survival benefits of neoadjuvant chemo(radio)therapy versus surgery first in patients with resectable or borderline resectable pancreatic cancer: a systematic review and meta-analysis

Study, year, country Study type, period Resectability status Definition of status Neoadjuvant treatment (proportion + protocol) Quality score
Barbier et al. [23], 2011, France Retro, 1997–2006 RPC Tumor surrounding ≤ 180° of the circumference of SMV/PV, no tumor contact to CA and SMA, and no occlusion of SMV/PV confluence. Chemo: 100%, 5-FU + cisplatine
Radio: 100%, 45 Gy
14
Papalezova et al. [24], 2012, America Retro, 1999–2007 RPC No evidence of tumor extension to SMA, CA, CHA, SMV, and PV. Radiographically borderline resectable or unresectable disease was excluded. Chemo: 100%, capecitabine or infusional 5-FU
Radio: 100%, 45 or 50.4 Gy
13
Tajima et al. [25], 2012, Japan Retro, 2006–2009 RPC/BRPC No detailed statement, but potentially resectable diseases were included. Chemo: 100%, GEM + S-1
Radio: 0%
12
Cho et al. [26], 2013, Korea Retro, 2002–2011 BRPC Tumor encasement of a short segment of CHA, without evidence of tumor extension to CA; tumor abutment of the SMA involving < 180° of the circumference; or short-segment occlusion of SMV/PV, allowing for vascular reconstruction. Chemo: 100%, GEM alone (most) or GEM + cisplatin or GEM + capecitabine
Radio: 100%, 45 or 50.4 or 58.4 Gy
14
Jiang et al. [27], 2013, China Retro, 2004–2010 RPC Tumors not involving major vascular structures including CA, SMA, and SMV/PV. Chemo: 72%, GEMa
Radio: 28%, 54 Gy
14
Patel et al. [28], 2014, America Retro, 1995–2010 RPC/BRPC Tumor abutment involving SMV/PV with or without narrowing or short-segment occlusion of the lumen allowing for safe resection, or tumor abutment of the SMA ≤ 180° of the circumference, or gastroduodenal artery encasement up to the hepatic artery with either short segment encasement or direct abutment of the hepatic artery, without extension to CA. Chemo: 100%, GEM + taxotere + capecitabine
Radio: 98%, 37.5 (30–50.5) Gy
12
Roland et al. [30], 2015, America Pro, 1990–2008 RPC No statement, but patients with borderline-resectable or locally advanced disease were excluded. Chemo: 100%, GEM, 5- FU or capecitabine
Radio: 98%, 30 or 50.4 Gy
12
Lee et al. [29], 2015, Korea Retro, 2000–2013 RPC/BRPC Tumor abutment (≤ 50% of the circumference) or encasement (> 50% of the circumference) of the SMV or PV. Chemo: 100%, GEM alone (most), GEM + cisplatin or GEM + capecitabine
Radio: 100%, 45 or 50.4 or 58.4 Gy
12
Sho et al. [31], 2015, Japan Retro, 2006–2013 RPC RPC—no tumor contact to CA, SMA, CHA, SMV/PV, or venous abutment of SMV/PV without distortion or narrowing. Chemo: 100%, GEM
Radio: 100%, 50 or 54 Gy
12
   BRPC BRPC—tumor with encasement of a short segment of CHA without evidence of tumor extension to CA, or tumor abutment of the SMA within 180° of circumference.   
Golcher et al. [36], 2015, Germany Pro, RCT, 2003–2009 RPC No organ infiltration except the duodenum and maximal involvement of peripancreatic vessels ≤ 180°. Chemo: 88%, GEM + cisplatin
Radio: 88%, 50.4 Gy
Low risk of biasb
Hirono et al. [32], 2016, Japan Retro, 2000–2013 BRPC Tumor abutment of SMA within 180° of the circumference, or CHA without extension of hepatic artery bifurcation, or CA without involvement of the aorta. Chemo: 100%, GEM + S-1 or S-1
Radio: 57%, 50 Gy
13
Masui et al. [33], 2016, Japan Pro, 2006–2010 RPC/BRPC Severe unilateral SMV/PV impingement, circumferential SMA abutment of less than 180°, or encasement of a short segment of the CHA. Chemo: 100%, GEM + S-1
Radio: 0%, NA
14
Ielpo et al. [3], 2017, Spain Pro, 2007–2016 RPC
BRPC
RPC—no radiographic evidence of vascular invasion.
BRPC—venous involvement of the SMV/PV; tumor abutment of the SMA within 180° of the circumference.
Chemo: 100%, GEM + nab-paclitaxel
Radio: 44%, ≤ 52 Gy
15
Murakami et al. [35], 2017, Japan Retro, 2002–2015 BRPC Tumor contact with SMA of ≤ 180° or tumor contact with CHA without extension to the CA or hepatic artery bifurcation, allowing for safe and complete resection and reconstruction. Chemo: 100%, GEM + S-1
Radio: 0%
13
Fujii et al. [34], 2017, Japan Pro, 2001–2013 RPC RPC—lesions without adjacent major vasculature including SMV/PV, SMA, CHA, and CA. Chemo: 100%, S-1
Radio: 100%, 50.4 Gy
15
RPC/BRPC
BRPC
BR-PV—lesions involved exclusively with the SMV/PV system.
BR-A—lesions involving gastroduodenal artery encasement up to the hepatic artery without extension to CA or ≤ 180° of tumor abutment to SMA.
Jang et al. [9], 2018, Korea Pro, RCT 2012–2014 BRPC Tumor abutment of SMA within 180 degrees of the circumference; tumor abutment of SMV/PV with impingement and narrowing of the lumen, or short-segment venous occlusion, allowing for safe resection and reconstruction. Chemo: 100%, GEM
Radio: 100%, 45 Gy
Low risk of biasb
Reni et al. [12], 2018, Italy Pro, RCT 2010–2015 RPC Lesions with the absence of invasion of superior mesenteric artery or vein, portal vein, coeliac artery, or hepatic artery. Chemo: 100%, cisplatin + epirubicin + capecitabine + GEM
Radio: 0%
Low risk of biasb
  1. Abbreviations: RPC resectable pancreatic cancer, BRPC borderline resectable pancreatic cancer, Retro retrospective, Pro prospective, RCT randomized controlled trial, Chemo chemotherapy, Radio radiotherapy, GEM gemcitabine, SMV superior mesenteric vein, PV portal vein, CA celiac axis, CHA common hepatic artery
  2. a72% of patients only received neoadjuvant chemotherapy while 28% of patients received neoadjuvant radiotherapy alone
  3. bTrials are RCTs evaluated by Cochrane Collaboration’s tool and the detailed result of assessment is showed in the Additional file 1: Table S6