Gemcitabine-Based Adjuvant Chemotherapy Following R1 Resection Still Improves Survival for Patients with Locally-Advanced Pancreatic Cancer
Keita Wada*, Hodaka Amano, Fumihiko Miura, Naoyuki Toyota, Kenichiro Kato, Makoto Shibuya, Susumu Kadowaki, Masahiro Yoshida, Ikuo Nagashima, Tadahiro Takada, Takehide Asano
Surgery, Teikyo University School of Medicine, Tokyo, Japan
Background: Radical resection (R0) is the surgical goal in pancreatic cancer surgery, but it often results in R1 resection. Sub-analysis of recent RCT (CONKO-001) for adjuvant chemotherapy with gemcitabine (GEM) showed significant advantage in patients with R1 resection, e.g. median disease free survival (DFS) was 15.8 months in patients with gemcitabine compared with 5.5 months in observation arm. In this study we evaluated the role of adjuvant chemotherapy with gemcitabine in locally-advanced pancreatic cancer treatment.
Methods: We reviewed the data of 277 patients who underwent pancreatic resection for pancreatic cancer at Teikyo university hospital, Tokyo, Japan during 1981-2007. Of 277 patients 37 patients have had liver metastasis at the time of operation and these cases were excluded in this study. Pancreaticoduodenectomy was performed in 68%, distal pancreatectomy in 19% and total pancreatectomy in 13%. Vascular resection was performed in 124 patients (52%). R0 resection was achieved in 62%, R1 was in 21%, and R2 was in 12%. Adjuvant chemotherapy with gemcitabine was used in 56%. Kaplan-Meier survival curve was calculated, and survival was compared by logrank test.
Results: Mortality was 2.9%. Morbidity was 37%. Median survival time (MST) for entire cohort was 18 months and 5-year survival was 15.9%. Survival comparing patients with GEM versus without GEM significantly different (MST: 22 vs. 13 months, P=0.003). Survival for patients having had R1 and R2 resection was significantly improved by the use of GEM-based adjuvant chemotherapy (Table& Figure).
Conclusion: Gemcitabine-based adjuvant chemotherapy significantly improves survival in patients with R1 resection approaching to the survival of patients with R0 resection. This result would support more radical surgical approach, such as vascular resection, in the management of locally-advanced pancreatic cancer, as long as surgical mortality, morbidity and patient’s quality of life is acceptable.
| MST w/GEM (M) | MST w/o GEM (M) | P | |
| R0 | 25 (N=86) | 28 (N=61) | n.s. |
| R1 | 22 (N=30) | 8 (N=21) | <0.001 |
| R2 | 9 (N=13) | 3 (N=16) | 0.006 |
