Long-term survival analysis based on tumor location in patients with pancreatic ductal adenocarcinoma who underwent pancreatectomy following neoadjuvant chemoradiotherapy

Purpose The study aimed at assessing whether long-term survival outcomes were different based on tumor location in patients with pancreatic ductal adenocarcinoma who underwent pancreatectomy following neoadjuvant chemoradiotherapy (CRT). Methods 286 patients with localized PDAC were enrolled and divided as head (Ph = 218), body (Pb = 34) and tail (Pt = 34). 5-year survival analyses were performed and independent predictors of disease-free survival (DFS) and overall survival (OS) were identified. Results Ph patients exhibited a higher incidence of initial clinical stage 3 tumors (48.2%) compared to Pb (29.4%) and Pt (0%), p  < 0.001 with more UR-LA cases (22.0%) compared to Pb (11.8%) and Pt (0%), p  < 0.001. However, they demonstrated a better response to CRT; Evans grades 3/4 in 49.1% Ph vs. 23.5% Pb and 26.5% Pt, p  = 0.015. 5-year DFS were; 26.4% (Ph) vs. 16.5% (Pb) vs. 33.1 (Pt), p  = 0.691 and OS; 25.4% (Ph) vs. 27.7% (Pb) vs. 32.0% (Pt), p  = 0.341. Significant predictors for both DFS and OS included CA19-9 levels, resection margins and pathological portal vein invasion, with tumor size and nodal invasion also influencing DFS, while pathological stage impacting OS. Conclusion Based on tumor location, long-term survival outcomes were comparable and was attributed to a better response to CRT by Ph than the Pb and Pt patients.