Accuracy of the END-PAC Model in Predicting the Risk of Developing Pancreatic Cancer in Patients with New-Onset Diabetes: A Systematic Review and Meta-Analysis.

OBJECTIVES: To investigate the performance of the END-PAC model in predicting pancreatic cancer risk in individuals with new-onset diabetes (NOD). METHODS: The PRISMA statement standards were followed to conduct a systematic review. All studies investigating the performance of the END-PAC model in predicting pancreatic cancer risk in individuals with NOD were included. Two-by-two tables, coupled forest plots and summary receiver operating characteristic plots were constructed using the number of true positives, false negatives, true negatives and false positives. Diagnostic random effects models were used to estimate summary sensitivity and specificity points. RESULTS: A total of 26,752 individuals from four studies were included. The median follow-up was 3 years and the pooled risk of pancreatic cancer was 0.8% (95% CI 0.6-1.0%). END-PAC score ≥ 3, which classifies the patients as high risk, was associated with better predictive performance (sensitivity: 55.8% (43.9-67%); specificity: 82.0% (76.4-86.5%)) in comparison with END-PAC score 1-2 (sensitivity: 22.2% (16.6-29.2%); specificity: 69.9% (67.3-72.4%)) and END-PAC score < 1 (sensitivity: 18.0% (12.8-24.6%); specificity: 50.9% (48.6-53.2%)) which classify the patients as intermediate and low risk, respectively. The evidence quality was judged to be moderate to high. CONCLUSIONS: END-PAC is a promising model for predicting pancreatic cancer risk in individuals with NOD. The score ≥3 should be considered as optimum cut-off value. More studies are needed to assess whether it could improve early pancreatic cancer detection rate, pancreatic cancer re-section rate, and pancreatic cancer treatment outcomes.

Neoadjuvant chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: Meta-analysis and trial sequential analysis of randomized controlled trials.

We aimed to compare resection and survival outcomes of neoadjuvant chemoradiotherapy (CRT) and immediate surgery in patients with resectable pancreatic cancer (RPC) or borderline resectable pancreatic cancer (BRPC). In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards, a systematic review of randomized controlled trials (RCTs) was conducted. Random effects modeling was applied to calculate pooled outcome data. Likelihood of type 1 or 2 errors in the meta-analysis model was assessed by trial sequential analysis. A total of 400 patients from four RCTs were included. When RPC and BRPC were analyzed together, neoadjuvant CRT resulted in a higher R0 resection rate (risk ratio [RR]: 1.55, p = 0.004), longer overall survival (mean difference [MD]: 3.75 years, p = 0.009) but lower overall resection rate (RR: 0.83, p = 0.008) compared with immediate surgery. When RPC and BRPC were analyzed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, p = 0.004) and overall survival (MD: 6.64, p = 0.004) of patients with BRPC. However, it did not improve R0 resection rate (RR: 1.18, p = 0.13) or overall survival (MD: 0.94, p = 0.57) of patients with RPC. Neoadjuvant CRT might be beneficial for patients with BRPC, but not for patients with RPC. Nevertheless, the best available evidence does not include contemporary chemotherapy regimens. Patients with RPC and those with BRPC should not be combined in the same cohort in future studies.