Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Jpn J Clin Oncol. 2020 May 5;50(5):483-489. doi: 10.1093/jjco/hyaa018.
The prognosis of pancreatic adenocarcinoma is dismal. Hence, advances in multidisciplinary treatment strategies, including surgery, are urgently needed. Early recurrence of distant organ metastases suggests that there are occult metastases even in cases with resectable disease. Several randomized controlled trials on adjuvant chemotherapy have been conducted to prolong survival after resection. CONKO-001 study was the first to demonstrate significant improvement in disease-free survival after surgery with gemcitabine administration. The JASPAC-01 study showed the superiority of adjuvant S1 over gemcitabine in survival after resection. Based on the results, adjuvant S1 therapy is the prescribed standard of care in Japan. Recently, the PRODIGE 24/CCTG PA.6 study showed that survival of patients treated with a modified FOLFIRINOX regimen as adjuvant therapy was significantly longer than those treated with adjuvant gemcitabine therapy. Although the evidence from these trials on adjuvant chemotherapy have been the gold-standard treatment for curatively resected and fully recovered patients, resectable disease at diagnosis is not the status, resected disease after curative resection. Currently, neoadjuvant therapy is considered to be a promising alternative to surgery for pancreatic cancer. Although there are many reports regarding neoadjuvant chemoradiotherapy, so far there has been no solid evidence proving the advantage of this strategy versus standard up-front surgery. Newly obtained results from the Prep-02/JSAP05 randomized phase II/III study, comparing neoadjuvant therapy with up-front surgery, revealed significant improvement in overall survival with neoadjuvant chemotherapy by intention-to-treat analysis. Thus, neoadjuvant intervention might become a new standard strategy in cases undergoing planned resection for pancreatic cancer.
胰腺腺癌的预后较差。因此，迫切需要在多学科治疗策略方面取得进展，包括手术。远处器官转移的早期复发表明，即使在可切除的疾病中也存在隐匿性转移。已经进行了几项关于辅助化疗的随机对照试验，以延长手术后的生存时间。CONKO-001 研究首次证明，在手术后给予吉西他滨治疗时，无病生存期显著延长。JASPAC-01 研究表明，辅助 S1 优于吉西他滨在手术后的生存。基于这些结果，辅助 S1 治疗在日本是规定的标准治疗方法。最近，PRODIGE 24/CCTG PA.6 研究表明，接受改良 FOLFIRINOX 方案辅助治疗的患者的生存时间明显长于接受吉西他滨辅助治疗的患者。虽然这些辅助化疗试验的证据是可治愈性切除和完全恢复的患者的金标准治疗方法，但可切除的疾病不是诊断时的状态，而是可切除的疾病在治愈性切除后。目前，新辅助治疗被认为是胰腺癌手术的一种有前途的替代方法。尽管有许多关于新辅助放化疗的报道，但迄今为止，还没有确凿的证据证明这种策略优于标准的一线手术。新获得的 Prep-02/JSAP05 随机 II/III 期研究结果表明，通过意向治疗分析，新辅助化疗在总体生存方面具有显著改善。因此，新辅助干预可能成为计划进行胰腺切除术的患者的一种新的标准策略。
