Reassessing standard neoadjuvant gemcitabine plus S-1 for resectable pancreatic head cancer: a retrospective cohort study.
- 1Department of Surgery, Teine Keijinkai Hospital, Hokkaido, Japan.
- 2Gastroenterological Surgery II, Department of Surgery, Hokkaido University Faculty of Medicine, Hokkaido, Japan.
Abstract
Neoadjuvant chemotherapy (NAC) with gemcitabine plus S-1 (GS) is the standard treatment for resectable pancreatic cancer (PC) in Japan. More intensive regimens, such as gemcitabine plus nab-paclitaxel (GnP), are widely used globally. However, whether the survival benefit observed in randomized trials can be reproduced in clinical practice remains unclear. This study aimed to compare oncological outcomes among patients treated with upfront surgery (UF), NAC-GnP, or NAC-GS to elucidate the potential optimal treatment strategy for anatomically resectable pancreatic head cancer. This retrospective single-center cohort study included patients with anatomically resectable pancreatic head cancer who underwent pancreaticoduodenectomy (PD) at a single institution between 2012 and 2022. The patients were classified according to their preoperative treatment strategy: UF, NAC-GnP, or NAC-GS. Perioperative outcomes, pathological findings, recurrence-free survival (RFS), and overall survival (OS) were compared between groups. Of the 206 patients who underwent PD, 196 were included in the three-group comparison (UF: 112; NAC-GnP: 45; NAC-GS: 39). The treatment era differed significantly among the groups. Perioperative outcomes, lymph node metastasis rates, R0 resection rates, postoperative adjuvant chemotherapy administration, recurrence patterns, OS, and RFS did not significantly differ among the groups. In the multivariable Cox regression analysis that used pretreatment variables, an initial carbohydrate antigen 19-9 (CA19-9) level ≥37 U/mL was independently associated with worse OS, whereas receipt of NAC was not significantly associated with OS. A clear survival advantage of NAC-GS or NAC-GnP over UF was not demonstrated in patients with anatomically resectable pancreatic head cancer who underwent PD. These findings highlight the need for improved strategies to identify patients most likely to benefit from neoadjuvant treatment.
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BibTeX
@article{kimura2026reassessing,
title = {{Reassessing standard neoadjuvant gemcitabine plus S-1 for resectable pancreatic head cancer: a retrospective cohort study.}},
author = {Kotaro Kimura and Shoki Sato and Zen Naito and Hiroyuki Yamamoto and Tomohiro Suzuki and Noriaki Kyogoku and Hirokatsu Katagiri and Takumi Yamabuki and Kentaro Kato and Minoru Takada and Yoshiyasu Ambo and Satoshi Hirano},
journal = {Journal of gastrointestinal oncology},
year = {2026},
month = oct,
doi = {10.21037/jgo-2026-0892},
url = {https://europepmc.org/article/MED/42996581},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Reassessing standard neoadjuvant gemcitabine plus S-1 for resectable pancreatic head cancer: a retrospective cohort study.
AU - Kotaro Kimura
AU - Shoki Sato
AU - Zen Naito
AU - Hiroyuki Yamamoto
AU - Tomohiro Suzuki
AU - Noriaki Kyogoku
AU - Hirokatsu Katagiri
AU - Takumi Yamabuki
AU - Kentaro Kato
AU - Minoru Takada
AU - Yoshiyasu Ambo
AU - Satoshi Hirano
PY - 2026
DA - 2026/10/23
JO - Journal of gastrointestinal oncology
DO - 10.21037/jgo-2026-0892
UR - https://europepmc.org/article/MED/42996581
AB - Neoadjuvant chemotherapy (NAC) with gemcitabine plus S-1 (GS) is the standard treatment for resectable pancreatic cancer (PC) in Japan. More intensive regimens, such as gemcitabine plus nab-paclitaxel (GnP), are widely used globally. However, whether the survival benefit observed in randomized trials can be reproduced in clinical practice remains unclear. This study aimed to compare oncological outcomes among patients treated with upfront surgery (UF), NAC-GnP, or NAC-GS to elucidate the potential optimal treatment strategy for anatomically resectable pancreatic head cancer. This retrospective single-center cohort study included patients with anatomically resectable pancreatic head cancer who underwent pancreaticoduodenectomy (PD) at a single institution between 2012 and 2022. The patients were classified according to their preoperative treatment strategy: UF, NAC-GnP, or NAC-GS. Perioperative outcomes, pathological findings, recurrence-free survival (RFS), and overall survival (OS) were compared between groups. Of the 206 patients who underwent PD, 196 were included in the three-group comparison (UF: 112; NAC-GnP: 45; NAC-GS: 39). The treatment era differed significantly among the groups. Perioperative outcomes, lymph node metastasis rates, R0 resection rates, postoperative adjuvant chemotherapy administration, recurrence patterns, OS, and RFS did not significantly differ among the groups. In the multivariable Cox regression analysis that used pretreatment variables, an initial carbohydrate antigen 19-9 (CA19-9) level ≥37 U/mL was independently associated with worse OS, whereas receipt of NAC was not significantly associated with OS. A clear survival advantage of NAC-GS or NAC-GnP over UF was not demonstrated in patients with anatomically resectable pancreatic head cancer who underwent PD. These findings highlight the need for improved strategies to identify patients most likely to benefit from neoadjuvant treatment.
SN - 2078-6891
SN - 2219-679X
ER -