SURVIVAL OUTCOMES OF VASCULAR AND LYMPHOVASCULAR INVASION AMONG PANCREATIC ADENOCARCINOMA PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Study aim: This systematic review aims to quantitatively assess vascular and lymphovascular invasion as prognostic factors for pancreatic adenocarcinoma. Methods: We carried out this systematic review meta-analysis in accordance with the PRISMA guidelines. We searched PubMed and EMBASE using EBSCO. We used Rayyan (Intelligent Systematic Reviews) website for duplication removal and study screening, and we used Review Manager 5.4 software to conduct a random-effect model meta-analysis pooling hazard ratios extracted from the included studies. Results: The study included 17 studies. The total number of participants from all studies was 5256 patients diagnosed with pancreatic cancer. The random-effects model analysis found that the pooled HR for vascular invasion is 1.37 (95% CI: 1.14, 1.6), where the test for the overall effect is significant (p<0.001). We found that the pooled HR for lymphovascular invasion is 1.44 (95% CI: 1.06, 1.83), where the test for the overall effect is significant (p<0.001). Analyses show significant inter-study heterogeneity for both investigations (I² > 50%). Conclusion: Our meta-analysis showed that both vascular invasion and lymphovascular invasion have poor prognosis and lower survival outcomes among patients with pancreatic cancer.