Tumor location as an indicator of survival in T1 resectable pancreatic ductal adenocarcinoma: a propensity score-matched analysis

Abstract

Background The latest 8th edition of the AJCC staging system emphasizes the importance of tumor size however, the clinical significance of the combination of tumor location with tumor size remains unknown. Methods We conducted this study to investigate the prognostic role of tumor location in T1 resectable pancreatic ductal adenocarcinoma (PDAC). Resectable PDAC patients from Surveillance, Epidemiology, and End Results (SEER) database (2004–2014) were selected for the propensity score matching analysis. We used matched cohort to analyze the relationship between clinicopathologic features and survival of patients. Result Eight thousand, four hundred nine patients were included in the propensity score matching analysis and 4571 patients were selected for final analysis. In T1 patients, the patients with pancreatic head tumor had worse prognosis compared to the patients with body/tail tumors. Multivariate analysis result showed that pancreatic body/tail location was an independent indicator for better chances of survival in T1 PDAC patients (hazard ratio, 0.69; 95%CI, 0.52–0.93; P = 0.01). The modified staging system was more efficient than the AJCC 8th staging system. Conclusion Modified staging system exhibited a good assessment of the survival rate. The tumor location is a good prognostic indicator for T1 resectable PDAC patients. Modification of T1 subgroup according to tumor location exhibited favorable survival prediction effects.

The Role of Location of Tumor in the Prognosis of the Pancreatic Cancer

“…Thus, earlier T categories (T1 and T2) demonstrated significantly worse median survival and 5-year survival (24 months and 21.8%) in the PHU group than in the PBT group (34 months and 37.2%) (p = 0.003). Meng et al [12] also found that resected pancreatic head cancers had worse outcomes in the earlier T stages, but significant difference was observed only for the T1 stage.…”

“…However, pancreatic cancer is usually treated according to the location. Many studies investigated pancreatic cancers separately according to the location [ 2 , 4 , 8 , 9 , 10 , 11 , 12 ]. Furthermore, many studies investigated whether the subjects underwent distal pancreatectomy or pancreatoduodenectomy, which is a reflection of the location of the tumor [ 13 , 14 , 15 , 16 ].…”

“…In the resected cases, pancreatic cancers in the head/uncinate region demonstrated significantly worse survival than those in the body/tail region. Many studies found similar results in resectable pancreatic cancers in the head/uncinate regions [ 11 , 12 , 18 ], while some studies failed to show worse results for the head region when compared to the body/tail region [ 9 , 10 , 13 , 14 , 15 , 16 , 19 ]. However, none of these studies showed significantly worse outcomes in pancreatic body/tail cancers [ 12 ].…”

Comparative genomic analysis of head and body/tail of pancreatic ductal adenocarcinoma at early and late stages

“…A large cohort analysis using the National Cancer Database of the United States from 1998 to 2011 demonstrated that among 40,980 cases of resected PDAC, pancreatic head cancers had advanced tumor stage, higher nodal positivity, worse tumor grade and poorer overall survival than pancreatic body/tail cancers [2]. A recent strictly propensity score-matched (e.g., race, gender, marital status, TMN stage and pathology grade) study including 4,571 resected T1 stage PDACs from Surveillance, Epidemiology, and End Results (SEER) database (2004-2014) provided the best evidence showing the prognostic value of tumor location in early-stage PDACs up to now [8]. They found that patients with pancreatic head cancer had a worse prognosis compared to those with pancreatic body/tail cancers.…”

Which Factors Are Associated With Positive Resection Margin in Pancreatic Ductal Adenocarcinoma for Different Surgical Procedures? Results Based on a Standard Pathological Evaluation System-retrospective Cohort Study 

“…Pancreatic body and tail tumors present late as they do not have symptoms in the early stages [33]. Thus, the pancreatic body and tail tumors are likely to invade beyond the pancreas.…”