Reassessing standard neoadjuvant gemcitabine plus S-1 for resectable pancreatic head cancer: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Institutions: Hokkaido University, Teine Keijinkai Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224088259