Association of the location of pancreatic ductal adenocarcinoma (head, body, tail) with tumor stage, treatment, and survival: a population-based analysis

Background: The association between pancreatic ductal adenocarcinoma (PDAC) location (head, body, tail) and tumor stage, treatment and overall survival (OS) is unclear. Methods: Patients with PDAC diagnosed between 2005 and 2015 were included from the population-based Netherlands Cancer Registry. Patient, tumor and treatment characteristics were compared with the tumor locations. Multivariable logistic and Cox regression analyses were used. Results: Overall, 19,023 patients were included. PDAC locations were 13,451 (71%) head, 2429 (13%) body and 3143 (16%) tail. Differences were found regarding metastasized disease (head 42%, body 69%, tail 84%, p 4 cm: 21%, 40%, 51%, p p Conclusions: PDAC locations in body and tail are larger, more often metastasized and less often resectable than in the pancreatic head. Whereas survival is similar after resection, survival in metastasized disease is somewhat less for PDAC in the pancreatic body and tail.

背景：胰腺导管腺癌（pancreatic ductal adenocarcinoma, PDAC）的发病部位（胰头、胰体、胰尾）与肿瘤分期、治疗方案及总生存期（overall survival, OS）之间的关联目前尚不明确。方法：本研究从基于人群的荷兰癌症登记处（Netherlands Cancer Registry）纳入2005年至2015年确诊的胰腺导管腺癌患者，按肿瘤发病部位分组，对比患者、肿瘤及治疗相关特征，并采用多变量logistic回归与Cox回归分析进行统计。结果：本研究共纳入19023例患者，其中胰头部位PDAC 13451例（占71%）、胰体2429例（占13%）、胰尾3143例（占16%）。研究发现不同部位肿瘤在转移性病情况（胰头42%、胰体69%、胰尾84%，p<0.001）、肿瘤直径＞4cm占比（21%、40%、51%，p<0.001）以及可切除性（胰头43%、胰体23%、胰尾18%，p<0.001）方面存在显著差异。转移性、不可切除及可切除患者的中位总生存期分别为5.8个月、3.0个月及2.0个月。接受切除治疗的患者中，胰头、胰体、胰尾PDAC的中位总生存期分别为29.0个月、23.0个月及24.0个月（p=0.18）；而发生远处转移的患者中，胰头、胰体、胰尾PDAC的中位总生存期分别为6.2个月、5.1个月及4.5个月（p=0.02）。结论：与胰头胰腺导管腺癌相比，胰体及胰尾部位的肿瘤体积更大、更易发生转移，且可切除率更低。尽管接受切除治疗后的患者总生存期相近，但发生转移的胰体及胰尾胰腺导管腺癌患者的总生存期略短于胰头患者。