Survival After Irreversible Electroporation in Unresectable Locally Advanced Pancreatic Cancer: A Meta-analysis.

INTRODUCTION: To evaluate the overall survival (OS) time and predictors of survival in patients with unresectable locally advanced pancreatic ductal adenocarcinoma (PDAC) who were treated with irreversible electroporation (IRE). METHODS: According to PRISMA guidelines, a systematic review and random-effects meta-analysis (single-arm and comparison) with meta-regression was conducted. All studies reporting OS time after IRE in patients with unresectable locally advanced PDAC were included. RESULTS: Thirty-one studies including 1296 patients were included. The OS time after IRE was 16.3 mo (95% CI: 14.2-18.4); it was longer in patients who received IRE than in those who did not (mean difference: 6.97 mo, 95% CI: 0.79-13.15, P = 0.03). The OS time was not affected by age (coefficient: -0.088, P = 0.722), male sex (coefficient: -0.049, P = 0.314), tumor size (coefficient: -0.049, P = 0.710), tumors located in the head of pancreas (coefficient: -3.141, P = 0.696), tumors located in the body or tail of pancreas (coefficient: 2.498, P = 0.747), and pretreatment chemotherapy (coefficient: 3.378, P = 0.233). Subgroup analyses showed that OS time was not affected by surgical (18.1 mo, 95% CI: 13.4-22.9) or percutaneous (14.9 mo, 95% CI: 12.2-17.6) approaches used or when IRE was combined with immunotherapy (20.3 mo, 95% CI: 5.4-35.2) or chemotherapy (18.5 mo, 95% CI: 15.5-21.4). CONCLUSIONS: IRE may improve OS time in patients with unresectable locally advanced PDAC (low-to-moderate certainty). The results of current study support the rationale for conducting future randomized trials in this setting and provide a robust basis for hypothesis generation and power analysis.