Comparison of adjuvant nab-paclitaxel plus gemcitabine, S-1 and gemcitabine chemotherapy for resectable pancreatic cancer: a real-world study

Purpose: The survival advantages of adjuvant AG ( nab-paclitaxel plus gemcitabine) or S-1 chemotherapy compared with GEM (gemcitabine) chemotherapy for resectable pancreatic cancer have been confirmed by the APACT study in 2019 and the JASPAC01 trial in 2016 respectively. However, the evidence about the effectiveness of AG or S-1 in real-world clinical practice is not sufficient. Methods Our study included 246 pancreatic cancer patients who underwent surgical treatment and received postoperative adjuvant chemotherapy with AG, S-1, or GEM scheme at Tianjin Medical University Cancer Institute and Hospital from June 2015 to July 2021. The primary outcome was overall survival (OS) and recurrence-free survival (RFS). In general, 246 patients were included, of whom 54(22%) received adjuvant AG, 103(41%) received adjuvant S-1, and 89(37%) received adjuvant GEM. Results Adjuvant S-1 was related to a prolonged OS compared to GEM (median OS S-1 vs GEM: 27.0 vs 20.0 months; HR: 0.65, P = .016) and a significantly prolonged RFS compared to GEM (median RFS S-1 vs GEM: 20.0 vs 8.2 months; HR: 0.58, P = .002). After adjusting for known prognostic factors in multivariate Cox regression analysis, this survival benefit persists and is consistent in most subgroups in our subgroup analysis. However, no statistically significant differences in OS or RFS were seen between the patients treated with AG and patients treated with GEM. Conclusion To conclude, this real-world study demonstrated that S-1 chemotherapy is associated with superior survival compared to GEM chemotherapy, while the survival advantage of AG chemotherapy compared to GEM chemotherapy remains to be further studied.