Neoadjuvant Gemcitabine Plus S-1 for Resectable Pancreatic Ductal Adenocarcinoma: A Propensity Score-matched Study.

Authors

Takashi Kishi, Kosuke Nakamura, Takayuki Tanaka, Kazunari Ishitobi, Shunsuke Kaji, Takahito Taniura, Takeshi Matsubara, Tetsu Yamamoto, Masaaki Hidaka

Published in

Anticancer research. Volume 46. Issue 9. Pages 5193-5204.

Abstract

Neoadjuvant chemotherapy with gemcitabine plus S-1 (NAC-GS) is recommended for patients with resectable pancreatic ductal adenocarcinoma (PDAC) in Japan. However, its real-world feasibility, the impact of treatment-related toxicity, and the influence of relative dose intensity (RDI) on outcomes remain unclear. This study evaluated the safety and efficacy of NAC-GS for resectable PDAC.
We retrospectively reviewed 117 patients with resectable PDAC who underwent treatment between January 2017 and December 2024. Outcomes were compared between patients treated with NAC-GS and those who underwent upfront surgery (UFS). Propensity score matching was performed among patients who underwent curative resection to adjust for baseline characteristics. Recurrence-free survival (RFS), overall survival (OS), recurrence patterns, adverse events, and the association between RDI and outcomes were analyzed.
The study included 46 patients in the NAC-GS group and 71 in the UFS group. Resection rates did not differ significantly between the groups. Although grade ≥3 adverse events occurred frequently in the NAC-GS group, no patient became ineligible for surgery because of treatment-related toxicity. After propensity score matching, 32 pairs were analyzed. The NAC-GS group had significantly longer RFS and OS than the UFS group. The 5-year RFS rates were 57.2% and 26.0%, respectively, and the 5-year OS rates were 60.2% and 37.2%, respectively. NAC-GS was also associated with a lower early recurrence rate. In the NAC-GS group, an RDI <70% tended to be associated with poorer survival.
NAC-GS was feasible and was associated with improved long-term outcomes and reduced early recurrence in patients with resectable PDAC. Maintaining adequate RDI may be important for maximizing its therapeutic benefit.

PMID:
42674690
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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