title: S-1 vs. gemcitabine as an adjuvant therapy after surgical resection for ductal adenocarcinoma of the pancreas.
abstract: BACKGROUND
  Pancreatectomy with regional lymphadenectomy remains the only curative treatment option for pancreatic cancer. There is no clear consensus on what type of adjuvant therapy should be used for patients with pancreatic cancer.
  
  
  OBJECTIVE
  Our objective was to retrospectively evaluate whether postoperative adjuvant chemotherapy using S-1 is clinically beneficial in managing resectable pancreatic cancer.
  
  
  METHODS
  Patients were divided into three groups: those undergoing surgery alone, those receiving gemcitabine infusion, and those receiving S-1 orally.
  
  
  RESULTS
  Of 189 studied patients, the median overall survival was 15.0 months after surgery alone, 33.0 months in the gemcitabine group, and 45.0 months in patients receiving S-1. A multivariate analysis identified regional lymph node metastasis, positive surgical margins, and absence of adjuvant chemotherapy as independent negative prognostic factors. S-1 was not inferior to gemcitabine in terms of survival outcomes and showed a favorable hazard ratio compared with gemcitabine in the subsets of patients with positive vascular invasion.
  
  
  CONCLUSIONS
  There was no difference between adjuvant chemotherapy with S-1 and gemcitabine in overall survival for patients with curative pancreatic cancer. Our results suggested that S-1 can be used as a second agent to gemcitabine after surgical resection for ordinary adenocarcinoma of the pancreas.
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan, takehiro_okabayashi@khsc.or.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.forename: Jun
authors.initials: J
authors.lastname: Iwata
authors.forename: Sojiro
authors.initials: S
authors.lastname: Morita
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Akihito
authors.initials: A
authors.lastname: Kozuki
authors.forename: Teppei
authors.initials: T
authors.lastname: Tokumaru
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Iiyama
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Kosaki
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D010094:Oxonic Acid / Q000627:therapeutic use*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D005641:Tegafur / Q000627:therapeutic use*; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine
references.citation: J Clin Oncol. 2008 Dec 20;26(36):5918-22
references.pmid: 19029412
references.citation: N Engl J Med. 2004 Mar 18;350(12):1200-10
references.pmid: 15028824
references.citation: N Engl J Med. 2004 Mar 18;350(12):1249-51
references.pmid: 15028829
references.citation: N Engl J Med. 2003 Nov 27;349(22):2117-27
references.pmid: 14645640
references.citation: J Clin Oncol. 2013 May 1;31(13):1640-8
references.pmid: 23547081
references.citation: CA Cancer J Clin. 2006 Mar-Apr;56(2):106-30
references.pmid: 16514137
references.citation: Br J Surg. 2007 Mar;94(3):265-73
references.pmid: 17318801
references.citation: Ann Surg. 2013 Apr;257(4):731-6
references.pmid: 22968073
references.citation: JAMA. 2007 Jan 17;297(3):267-77
references.pmid: 17227978
references.citation: Ann Oncol. 2003 May;14(5):675-92
references.pmid: 12702520
references.citation: Cancer Sci. 2011 Feb;102(2):478-83
references.pmid: 21143703
references.citation: Cancer Chemother Pharmacol. 2008 Apr;61(4):615-21
references.pmid: 17520253
references.citation: Oncology. 2005;69(5):421-7
references.pmid: 16319514
references.citation: JAMA. 2010 Sep 8;304(10):1073-81
references.pmid: 20823433
references.citation: J Clin Oncol. 2008 May 1;26(13):2118-23
references.pmid: 18445840
references.citation: N Engl J Med. 2011 May 12;364(19):1817-25
references.pmid: 21561347
references.citation: Jpn J Clin Oncol. 2008 Mar;38(3):227-9
references.pmid: 18272475
references.citation: Ann Surg. 2002 Sep;236(3):355-66; discussion 366-8
references.pmid: 12192322
references.citation: Ann Oncol. 2009 May;20 Suppl 4:37-40
references.pmid: 19454458
references.citation: Ann Surg. 2011 Dec;254(6):882-93
references.pmid: 22064622
references.citation: JOP. 2013 Mar 10;14(2):119-22
references.pmid: 23474550
references.citation: J Surg Oncol. 2012 Aug 1;106(2):174-80
references.pmid: 22331838
references.citation: Cancer Chemother Pharmacol. 2013 Feb;71(2):419-29
references.pmid: 23178955
references.citation: JAMA. 2008 Mar 5;299(9):1019-26
references.pmid: 18319412