Abstract
Pancreatic cancer has a dismal prognosis, although this may improved by curative surgery and adjuvant chemotherapy, we undertook an observational study to clarify whether adjuvant chemotherapy with gemcitabine provides an overall survival advantage in patients undergoing curative resection for pancreatic cancer. Patients and Methods: Subject were 213 patients undergoing curative resection for histologically verified pancreatic cancer (resection rate: 55%) from August 1981 to March 2007. Of these, 133 without adjuvant chemotherapy were assigned to a control group and 80 underwent adjuvant chemotherapy with gemcitabine in a gemcitabine group (intension-to-treat). Survival was analyzed, and the two groups compared. Results: Median survival was 21.1 months in the gemcitabine group and 12.2 months in the control group. Overall survival differed significantly between groups (p=0.029, log-rank) (hazard ratio: 0.785, 95%cCI: 0.642-0.949), and the survival curve was significantly better in the gemcitabine group than in the control group in a subgroup of patients who showed unfavorable factors, i.e., microscopic residual tumor (R1), lymph node metastasis, portal vein invasion, extrapancreatic nerve plexus invasion, and tumor of the pancreatic head. The survival curve for patients undergoing adjuvant chemotherapy for longer than 3 months (n=47) was significantly better than for those undergoing less than 3 months (n=20). Conclusions: Adjuvant chemotherapy with gemcitabine significantly prolonged overall survival in patients undergoing curative resection for pancreatic cancer.
