Disparities in survival by stage after surgery between pancreatic head and body/tail in patients with nonmetastatic pancreatic cancer.

Rui Wang,Zhenjiang Zheng,Jason S. Gold,Chunlu Tan,Jie Ping,Yonghua Chen,Mojin Wang,Xubao Liu

doi:10.1371/journal.pone.0226726

Abstract

BackgroundThe survival of pancreatic cancer patients with lesions in different locations is unclear. In addition, the different surgery types for nonmetastatic pancreatic head cancer (PHC) or body/tail cancer (PBTC) have different prognostic influences. We analyzed the association by stage between tumor location (head vs. body/tail) and survival of nonmetastatic pancreatic cancer patients who underwent surgery.MethodsWe identified stages I to III pancreatic cancer patients who underwent surgery from 2004 through 2015 by using the Surveillance, Epidemiology, and End Results (SEER) database. The adjusted hazard ratio (HR) and 95% confidence interval (CI) for cancer-specific survival (CSS) were obtained using Cox regression.ResultsA total of 13517 patients or 86.6% had PHC. PHC patients were more likely to have an advanced tumor stage, higher tumor grade, and more frequent and a higher number of positive lymph nodes compared with PBTC patients. The PHC patients had a worse CSS than PBTC patients (P<0.001) and were predominantly at stage I (P = 0.008) and II (P = 0.004). Multivariate Cox regression analysis showed that PHC was an independent prognostic factor associated with a worse CSS in pancreatic cancer patients (HR 1.132, 95% CI 1.042–1.228, P = 0.003), predominantly at stage II (HR 1.128, 95% CI 1.030–1.235, P = 0.009).ConclusionAt a resectable early stage, the PHC patients had a worse CSS than PBTC patients after surgery. PHC was an independent prognostic factor associated with worse survival in pancreatic cancer patients, predominantly at stage II.

Highlights

Pancreatic cancer is the fourth leading cause of cancer-related deaths for both men and women in the United States, with 56770 new cases and 45750 deaths in 2019. [1] Pancreatic cancer can be divided into head and body/tail cancer according to the anatomy location
pancreatic head cancer (PHC) patients were more likely to have an advanced tumor stage, higher tumor grade, and more frequent and a higher number of positive lymph nodes compared with pancreatic body/tail cancers (PBTC) patients
The PHC patients had a worse cancer-specific survival (CSS) than PBTC patients (P

Summary

Introduction

Pancreatic cancer is the fourth leading cause of cancer-related deaths for both men and women in the United States, with 56770 new cases and 45750 deaths in 2019. [1] Pancreatic cancer can be divided into head and body/tail cancer according to the anatomy location. [1] Pancreatic cancer can be divided into head and body/tail cancer according to the anatomy location. [7,8,9] in the population-based study, 4% of patients with pancreatic tail cancer had an inappropriate surgical procedure (e.g., pancreaticoduodenectomy). Winer et al.[10] found, by using the National Cancer Database, that patients with PHC had worse overall survival than either body or tail locations for all stages combined. The different surgery types for nonmetastatic pancreatic head cancer (PHC) or body/tail cancer (PBTC) have different prognostic influences. We analyzed the association by stage between tumor location (head vs body/tail) and survival of nonmetastatic pancreatic cancer patients who underwent surgery

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