title: [Efficacy of neoadjuvant chemotherapy for resectable pancreatic carcinoma].
abstract: Surgery followed by adjuvant chemotherapy is standard care for resectable pancreatic carcinoma. The maximum estimated 2-year survival rate associated with this strategy is nearly 50%. The use of neoadjuvant therapy for pancreatic cancer remains controversial, and its efficacy has not been elucidated. To evaluate the efficacy of neoadjuvant chemotherapy for planned pancreatic cancer resection, the oncological outcomes of neoadjuvant gemcitabine plus S-1 combination therapy( GS therapy) and a surgery-first approach were retrospectively compared. Patients with planned pancreatic cancer resection and without major artery abutments were enrolled in this study. There were 39 cases of neoadjuvant GS therapy (N group) and 93 cases of the surgery-first approach( S group). Survival and surrogate markers, including the R0 rate, the "true R0 rate"( R0 with tumor marker normalization after resection), and N0 rate, were compared. The groups did not differ significantly in terms of age, gender, or tumor location. The resection rates of the N and S groups were similar (92% and 86%, respectively). The median survival of the N group (39.4 months) was significantly longer than that of the S group (20.8 months) in intention-to-treat analysis (p=0.0009). The R0, true R0, and N0 rates of the N group (85%, 69%, and 44%, respectively) were higher than those of the S group( 72%, 48%, and 24%, respectively). In conclusion, this retrospective analysis showed that neoadjuvant GS therapy might be more effective than the standard surgery-first strategy in terms of oncological outcomes for resectable pancreatic cancer. A prospective randomized study, Prep-02/JSAP-05, which compares neoadjuvant therapy to the surgery-first approach, is ongoing (UMIN-No. 000009634).
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Hospital.
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.forename: Kei
authors.initials: K
authors.lastname: Kawaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoki
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Kudo
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yabuuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Fukase
authors.forename: Masamichi
authors.initials: M
authors.lastname: Mizuma
authors.forename: Naoaki
authors.initials: N
authors.lastname: Sakata
authors.forename: Shigeru
authors.initials: S
authors.lastname: Otsutomo
authors.forename: Takanori
authors.initials: T
authors.lastname: Morikawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Kei
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Takaho
authors.initials: T
authors.lastname: Okada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Naitoh
authors.forename: Yu
authors.initials: Y
authors.lastname: Katayose
authors.forename: Shinichi
authors.initials: S
authors.lastname: Egawa
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors