Effect of Severe Neutropenia Caused by S-1 Adjuvant Chemotherapy on Pancreatic Cancer Prognosis.

In Japan, S-1 is used as adjuvant chemotherapy for pancreatic cancer. Neutropenia during S-1 chemotherapy is reported to be an independent predictor of prolonged survival in patients with advanced gastric cancer. However, this is unclear in pancreatic cancer. This study aimed to examine the effect of severe neutropenia caused by S-1 adjuvant chemotherapy on pancreatic cancer prognosis: overall survival (OS) and recurrence-free survival (RFS), and the potential effect of the duration from surgery to S-1 administration on OS and RFS. This single-center, retrospective, observational study included patients who newly received S-1 adjuvant chemotherapy after curative resection of pancreatic cancer at the Japanese Red Cross Kyoto Daini Hospital between January 1, 2016, and September 30, 2020. Of the 43 patients, 9 had grade 3 or higher neutropenia (G3 group) and had a significantly longer median OS than the other 34 (non-G3 group) did. The median RFS of the G3 group was longer than that of the non-G3 group. The median time from surgery to S-1 administration was significantly shorter in the G3 group than in the non-G3 group. Cox proportional hazards regression analysis revealed that duration from surgery to S-1 administration <51 d (hazard ratio: 0.375, 95% confidence interval: 0.154-0.914, p = 0.031) and occurrence of grade 3 neutropenia (hazard ratio: 0.198, 95% confidence interval: 0.046-0.860, p = 0.031) were significantly associated with prolonged OS. In conclusion, initiating S-1 adjuvant chemotherapy early after surgery and the occurrence of grade 3 neutropenia may improve pancreatic cancer prognosis.