The Influence of HR, IT, and Market Knowledge Competencies on the Performance of HR Managers in Food Exporting Companies in Thailand

Abstract

There have been a few large randomised controlled trials of adjuvant treatment following resection in pan-creatic cancer that have now enabled the establishment of the standard of care. Pancreatic cancer is one of the major causes of cancer death with a five-year survival rate of less than 5%. Patients who can undergo surgical resection have a better outlook and in specialised centres resection rates of above 15% can be achieved. The five-year survival improves to around 10% following resection, although cure cannot be achieved in the vast majority of cases. There is an obvious need to improve long-term survival in these patients. The first adjuvant study ever undertaken was by the North American Gastrointestinal Tumor Study Group (GITSG) who randomised 43 patients between chemoradiation (40 Gy with weekly 5-Fluorouracil (5FU) for two years) vs. surgery alone [1]. Median survival was significantly increased in the treated group (20 vs. 11 months, P = 0.035) with 2-year survival estimates of 42% vs. 15%. This was considered enough evidence to make chemoradiation standard treatment in America. The European Study Group for Pancreatic Cancer (ESPAC) 1 trial was the first adequately powered, ran-domised study to assess chemoradiotherapy concurrent with 5-fluorouracil and maintenance 5-fluorouracil and folinic acid chemotherapy in resected pancreatic cancer [2]. Initial analysis of all 541 patients indicated no survival benefit for adjuvant chemoradiotherapy but the results for chemotherapy were considered to be inconclusive with only ten months' median follow-up. The final results of this trial after a median follow-up of 47 months in the 289 patients restricted to the original 2x2 factorial design definitively demonstrated a survival benefit for chemotherapy, but not for chemoradiotherapy [3]. In the 2×2 factorial design 73 patients were randomised to chemoradiation, 75 to chemotherapy, 72 for both and 69 to observation. Analysis was based on 237 (82%) deaths and a median (inter-quartile range) follow-up of 47 (33, 62) months. Five-year survival for patients receiving chemoradi-ation was 10.0% and 19.6% without (P = 0.05) and 21.1% for patients receiving chemotherapy and 8.4% without (P = 0.009). Five-year survival estimates were 10.7% for patients randomised to observation, 7.3% for patients randomised to chemoradiation only, 29.0% for the patients randomised to chemotherapy only and 13.2% for patients randomised to chemoradiation followed by chemotherapy. The chemotherapy benefit remained when adjusting for influential prognostic factors. Quality of life improved after adjuvant therapy irrespective of the modality or combination of modalities [4]. A survival advantage was also demonstrated for adjuvant combination chemotherapy using 5-FU, doxorubicin and mitomycin C in another randomised controlled trial [5]. A meta-analysis using individual patient data showed that the survival benefit of adjuvant chemotherapy extended to patients with R1 resection margins although the treatment effect was much less [6]. The failure of adjuvant chemoradiotherapy to enhance survival was also reflected in the results of the European Organisation for Research and Treatment of Cancer multicentre prospective randomised trial [7,8]. 218 patients (104 with ampullary tumours) were randomised between adjuvant chemoradiation (as in the GITSG regimen, but with no follow-on chemotherapy) vs. surgery alone. Median survival was not significantly increased with treatment (17 vs. 13 months) with two-year and five-year survival estimates of 37% vs. 23% and 20% vs. 10% in 114 patients with tumours in the pancreatic head. The Radiation Therapy Oncology Group (RTOG) 9704 trial randomised 538 patients to either pre-and post-chemoradiation gemcitabine or to pre-and post-chemoradiation 5-fluorouracil [9]. The median survival in the 451 'eligible' patients was 16.7 and 18.8 months respectively (P = 0.34) and in the 388 patients with pancreas head cancer 20.5 months versus 16.9 months respectively (P = 0.09). This trial of course does not support the principle adjuvant S378