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. 2021 Nov 17;9(11):1706.
doi: 10.3390/biomedicines9111706.

Comparison of Characteristics and Survival Rates of Resectable Pancreatic Ductal Adenocarcinoma according to Tumor Location

Min Kyu Sung  1 , Yejong Park  1 , Bong Jun Kwak  1 , Eunsung Jun  1   2 , Woohyung Lee  1 , Ki Byung Song  1 , Jae Hoon Lee  1 , Dae Wook Hwang  1 , Song Cheol Kim  1
Affiliations

Comparison of Characteristics and Survival Rates of Resectable Pancreatic Ductal Adenocarcinoma according to Tumor Location

Min Kyu Sung et al. Biomedicines. .

Abstract

The impact of tumor location on patient survival in pancreatic ductal adenocarcinoma (PDAC) remains controversial. This study investigated the association between primary tumor location and survival rates for resectable PDAC. Additionally, we assessed if this association remains consistent across categories of the Tumor-Node-Metastasis staging system. We analyzed 2471 patients who underwent surgical resection between 2000 and 2018 at a single center. Subgroup analysis was performed according to the Tumor-Node-Metastasis staging system. Among the group, 67.9% (1677 patients) had pancreatic head cancer (PHC) and 32.1% (794 patients) had pancreatic body/tail cancer (PBTC). Patients with PHC had worse overall survival and worse disease-free survival than those with PBTC. Patients with PHC had worse survival in stage IB and stage IIB than those with PBTC. No significant difference was observed for stages IA, IIA, and III. Multivariate analysis showed that elevated CA 19-9, mGPS, a longer hospital stay, complication, accompanying vein resection, larger tumor size, worse differentiation, higher TNM stage (stage IIB, III, IV), presence of LVI, and positive resection margin were risk factors for poor survival after resection. In resectable PDAC, patients with PHC had worse overall and disease-free survival than those with PBTC. However, tumor location was not an independent prognostic factor for PDAC.

Keywords: body/tail; head; location; pancreatic ductal adenocarcinoma; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves of the cases in pancreatic head cancer (PHC) group (n = 1677) and pancreatic body/tail cancer (PBTC) group (n = 704). (a) The median overall survival (OS) and estimated 1-, 3-, and 5-year OS rates were 24.0 months and 75.0%, 25.2%, and 13.0% in the PHC group, and 34.0 months and 79.5%, 30.6%, and 14.7% in the PBTC group, respectively (p = 0.001). (b) The median disease-free survival (DFS) and estimated 1-, 3-, and 5-year DFS rates were 12.0 months and 41.5%, 14.3%, and 8.6% in the PHC group, and 18.0 months and 48.4%, 20.7%, and 11.5% in the PBTC group, respectively (p = 0.0012).
Figure 2
Figure 2
Kaplan–Meier survival curves of the cases in pancreatic head cancer (PHC) group (n = 1348) and pancreatic body/tail cancer (PBTC) group (n = 626), stratified according to cancer stage (I/II or III). (a) The median overall survival (OS) and estimated 1-, 3-, and 5-year OS rates for stage I/II were 24.0 months and 77.7%, 27.9%, and 14.8% in the PHC group, and 30.0 months and 82.3%, 33.4%, and 16.6% in the PBTC group, respectively (p = 0.002). (b) The median disease-free survival (DFS) and estimated 1-, 3-, and 5-year DFS rates for stage I/II were 10.0 months and 46.0%, 16.4%, and 9.9% in the PHC group, and 13.0 months and 52.7%, 23.5%, and 13.1% in the PBTC group, respectively (p = 0.0019). (c,d) However, no significant difference was found between PHC patients and those with stage III PDAC (overall survival: p = 0.1, disease-free survival: p = 0.099).
Figure 2
Figure 2
Kaplan–Meier survival curves of the cases in pancreatic head cancer (PHC) group (n = 1348) and pancreatic body/tail cancer (PBTC) group (n = 626), stratified according to cancer stage (I/II or III). (a) The median overall survival (OS) and estimated 1-, 3-, and 5-year OS rates for stage I/II were 24.0 months and 77.7%, 27.9%, and 14.8% in the PHC group, and 30.0 months and 82.3%, 33.4%, and 16.6% in the PBTC group, respectively (p = 0.002). (b) The median disease-free survival (DFS) and estimated 1-, 3-, and 5-year DFS rates for stage I/II were 10.0 months and 46.0%, 16.4%, and 9.9% in the PHC group, and 13.0 months and 52.7%, 23.5%, and 13.1% in the PBTC group, respectively (p = 0.0019). (c,d) However, no significant difference was found between PHC patients and those with stage III PDAC (overall survival: p = 0.1, disease-free survival: p = 0.099).
Figure 3
Figure 3
Kaplan–Meier survival curves of the cases in pancreatic head cancer (PHC) group and pancreatic body/tail cancer (PBTC) group, stratified according to the American Joint Committee on Cancer (AJCC 8th edition) Tumor-Node-Metastasis (TNM) staging system. (b) The survival rates were lower in PHC patients compared with PBTC patients in stage IB (30 months vs. 42 months, p = 0.011) and (d) stage IIB (19 months vs. 23 months, p = 0.048). (a,c) No significant difference between the two groups was observed for stages IA and IIA.
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