Abstract 338P
Background
Pancreatic ductal adenocarcinoma (PDAC) is expected to become the 2nd deadliest cancer in Europe by 2030. A better understanding of the clinical and molecular patterns is needed to improve therapeutic management. Given the underlying differences in embryogenesis, the objectives of this study were to describe the clinical, molecular features and outcomes of PDAC based on the location at diagnosis (head or tail).
Methods
Retrospective analysis was performed using a single academic center database. Data on demographics, risk factors, systemic therapy, best radiographical response, molecular alterations, progression free survival (PFS), and overall survival (OS) were collected. HR and P value were computed via cox regression between Head (H) versus Body-Tail tumors (BT).
Results
Overall, 961 patients were included. The median age was 63 years, 513 patients (52%) were men and 32% of patients had a smoking history. At diagnosis, 268 pts (28%) had resectable or borderline disease, 130 had locally-advanced disease (13.5%) and 563 (58.5%) had metastatic cancer. Half of the tumors were located in the head. At metastasis diagnosis, 71% of patients had liver-only metastases, 15% lung-only and 14% peritoneum-only metastases. Molecular alterations were available for 357 patients. The most common genes altered were in KRAS (80%), TP53 (69%), CDKN2A (23%), and SMAD4 (11%). The molecular profile was similar between the 2 groups. The median OS was 20.2 months [95% CI : 18.9-22.3] in H tumors compared to 16.1 months in B/T tumors [95% CI : 13.9-17.5] (HR : 0.78, p=0.00065). Women (HR: 0.82, p=0.009) and patients with a family history of cancer (HR: 0.26, p<0.001) seem to have a longer OS while a high NLR ratio seemed to worsen the prognosis (HR : 2.52, p<0.001).
Conclusions
In a large retrospective cohort, patients with head PDAC were found to have a longer median OS than body and tail location from initial diagnosis. Other factors associated with a better outcome are a family history of cancer, low NLR ratio and female sex.
Legal entity responsible for the study
Gustave Roussy.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.