Tajima Hidehiro, Ohta Tetsuo, Kitagawa Hirohisa, Okamoto Koichi, Sakai Seisho, Makino Isamu, Kinoshita Jun, Furukawa Hiroyuki, Nakamura Keishi, Hayashi Hironori, Oyama Katsunobu, Inokuchi Masafumi, Nakagawara Hisatoshi, Fujita Hideto, Takamura Hiroyuki, Ninomiya Itasu, Fushida Sachio, Tani Takashi, Fujimura Takashi, Ikeda Hiroko, Kitamura Seiko
Department of Gastroenterologic Surgery, Division of Cancer Medicine, Graduate School of Medicine Science, Kanazawa University;
Exp Ther Med. 2012 May;3(5):787-792. doi: 10.3892/etm.2012.482. Epub 2012 Feb 13.
Results of surgery alone for pancreatic cancer are disappointing. We retrospectively evaluated the efficacy and tolerability of neoadjuvant chemotherapy (NAC) with gemcitabine and oral S-1 in patients with potentially resectable pancreatic cancer. A total of 34 patients with pancreatic ductal adenocarcinoma, radiologically diagnosed preoperatively as having potentially resectable tumors, underwent pancreatic resection with lymphadenectomy at Kanazawa University Hospital. NAC was administered to 13 patients (NAC group). The remaining 21 patients were surgically treated without preoperative chemotherapy (control group). Surgical results were compared between these two groups, with follow-up for at least 24 months. No statistically significant differences were found in the clinicopathological background data (tumor location, age, gender, lymph node metastases, tumor stage and tumor size) between the NAC and control groups. Following preoperative chemotherapy, no patients were judged to be unable to undergo laparotomy, i.e., neither distant metastasis nor tumor progression was observed. Radiologically, all 13 NAC group patients had stable disease, whereas, histopathologically, all tumor specimens showed evidence of tumor cells. The treatment effect was judged by Evans grading to be grade IIa in 11 patients and grade IIb in 2 patients. Toxicity was evaluated in 11 patients. Grade III side effects were regarded as hematological toxicity, i.e., leucopenia (7.7%) and thrombocytopenia (15.4%). Moreover, the incidence of perioperative complications did not differ significantly between the NAC and control groups. The one- and three-year overall survival rates of the NAC group with pancreatic head cancer were 88.9 and 55.6%, respectively, superior to 88.9 and 29.6% in the control group (p=0.055). Therefore, NAC with gemcitabine and S-1 is well tolerated and potentially effective against pancreatic head cancer. A phase I study of NAC with gemcitabine and S-1 is under way in patients with resectable pancreatic cancer.
单独手术治疗胰腺癌的效果令人失望。我们回顾性评估了吉西他滨联合口服S-1新辅助化疗（NAC）对潜在可切除胰腺癌患者的疗效和耐受性。共有34例术前经放射学诊断为具有潜在可切除肿瘤的胰腺导管腺癌患者，在金泽大学医院接受了胰腺切除及淋巴结清扫术。13例患者接受了NAC治疗（NAC组）。其余21例患者未接受术前化疗直接接受手术治疗（对照组）。比较两组的手术结果，并进行至少24个月的随访。NAC组和对照组在临床病理背景数据（肿瘤位置、年龄、性别、淋巴结转移、肿瘤分期和肿瘤大小）方面未发现统计学上的显著差异。术前化疗后，没有患者被判定无法进行剖腹手术，即未观察到远处转移或肿瘤进展。放射学检查显示，NAC组的13例患者病情均稳定，而组织病理学检查显示，所有肿瘤标本均有肿瘤细胞。根据埃文斯分级，11例患者的治疗效果为Ⅱa级，2例为Ⅱb级。对11例患者进行了毒性评估。Ⅲ级副作用被视为血液学毒性，即白细胞减少（7.7%）和血小板减少（15.4%）。此外，NAC组和对照组围手术期并发症的发生率无显著差异。NAC组胰头癌患者的1年和3年总生存率分别为88.9%和55.6%，优于对照组的88.9%和29.6%（p = 0.055）。因此，吉西他滨联合S-1的NAC耐受性良好，对胰头癌可能有效。一项关于吉西他滨联合S-1的NAC的I期研究正在可切除胰腺癌患者中进行。
