新辅助吉西他滨和S-1治疗胰腺导管腺癌：对营养状况和胰十二指肠切除术结局的影响。

Neoadjuvant gemcitabine and S-1 in pancreatic ductal adenocarcinoma: Effects on nutritional status and pancreaticoduodenectomy outcomes.

作者信息

Takamoto Takeshi, Nara Satoshi, Ban Daisuke, Mizui Takahiro, Miyata Akinori, Esaki Minoru

机构信息

Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.

出版信息

Surgery. 2025 Apr;180:109026. doi: 10.1016/j.surg.2024.109026. Epub 2024 Dec 30.

DOI:10.1016/j.surg.2024.109026

PMID:39740600

Abstract

BACKGROUND

With the advent of improved chemotherapy options, neoadjuvant chemotherapy has gained acceptance as a multidisciplinary treatment approach for localized pancreatic ductal adenocarcinoma. This study aimed to clarify whether neoadjuvant chemotherapy with gemcitabine and S-1 influences preoperative nutritional status and postoperative outcomes, particularly in patients undergoing highly invasive pancreatic resection.

METHODS

Patients with resectable pancreatic ductal adenocarcinoma who underwent pancreaticoduodenectomy as upfront surgery or after neoadjuvant chemotherapy with gemcitabine and S-1 between January 2015 and December 2022 were assessed. In addition to perioperative surgical outcomes, preoperative nutritional status was evaluated using serum albumin, controlling nutritional status, and prognostic nutritional index.

RESULTS

A total of 158 patients who underwent upfront pancreaticoduodenectomy and 119 who received neoadjuvant chemotherapy with gemcitabine and S-1 before pancreaticoduodenectomy were evaluated. Preoperative nutritional assessments (serum albumin, controlling nutritional status score, and prognostic nutritional index) showed no significant differences between groups, either at the initial consultation or immediately before surgery. No significant differences were observed in postoperative outcomes, including blood loss, operation time, and morbidity. The neoadjuvant chemotherapy with gemcitabine and S-1 group had a significantly greater rate of negative tumor margins (R0 resection rate 86% vs 74%, P = .018), and improved overall survival (hazard ratio, 0.41; 95% confidence interval, 0.25-0.67, P < .001) compared with the upfront pancreaticoduodenectomy group.

CONCLUSIONS

Neoadjuvant chemotherapy with gemcitabine and S-1 does not adversely impact preoperative nutritional status and enhances the effectiveness of pancreaticoduodenectomy for resectable pancreatic ductal adenocarcinoma, leading to improved pathologically curative resection rates and overall survival.

摘要

背景

随着化疗方案的改进，新辅助化疗已成为局部胰腺导管腺癌多学科治疗方法并获得认可。本研究旨在阐明吉西他滨联合S-1新辅助化疗是否会影响术前营养状况和术后结局，尤其是在接受高侵袭性胰腺切除术的患者中。

方法

评估了2015年1月至2022年12月间因可切除胰腺导管腺癌接受胰十二指肠切除术作为初始手术或接受吉西他滨联合S-1新辅助化疗后再行胰十二指肠切除术的患者。除围手术期手术结局外，还使用血清白蛋白、控制营养状况和预后营养指数评估术前营养状况。

结果

共评估了158例接受初始胰十二指肠切除术的患者和119例在胰十二指肠切除术前行吉西他滨联合S-1新辅助化疗的患者。术前营养评估（血清白蛋白、控制营养状况评分和预后营养指数）在初诊时或手术前即刻两组之间均无显著差异。术后结局，包括失血量、手术时间和发病率，均未观察到显著差异。与初始胰十二指肠切除术组相比，吉西他滨联合S-1新辅助化疗组的阴性切缘率显著更高（R0切除率86%对74%，P = 0.018），总生存期得到改善（风险比，0.41；95%置信区间，0.25 - 0.67，P < 0.001）。