Background:Pancreatic ductal adenocarcinoma (PDAC) exhibits variable survival outcomes based on tumor location, with pancreatic head cancer (PHC) and pancreatic body/tail cancer (PBTC) differing in prognosis and treatment response. This study investigates the correlation between tumor location and survival outcomes in PDAC patients treated with standard chemotherapy regimens.Methods:A retrospective analysis of 604 PDAC patients (400 PHC, 204 PBTC) diagnosed between January 2015 and May 2024 at Houston Methodist Neal Cancer Center was conducted. Patients received either mFOLFIRINOX or gemcitabine/nab-paclitaxel as first-line therapy. Clinical data, including demographics, tumor stage, treatment modalities, and molecular profiles, were extracted from electronic records. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan–Meier analyses and Cox proportional hazards models. Latent class analysis (LCA) identified patient subgroups based on shared clinical, demographic, and survival characteristics.Results:PHC patients demonstrated superior median OS (12 months) compared to PBTC (9 months,p= 0.012) and PFS (8 months vs. 5 months,p= 0.0008). Across both subtypes, mFOLFIRINOX was associated with significantly longer OS than gem/nab-paclitaxel (PHC: 18.8 vs. 12.7 months,p< 0.0001; PBTC: 14 vs. 6 months,p= 0.011). LCA revealed distinct clusters: in PHC, a curative-intent class (median OS > 24 months) contrasted with a palliative class (<6 months); in PBTC, an aggressive treatment class (median OS > 18 months) differed from a limited treatment class (<6 months). Cluster differences were linked to treatment intensity, stage, and radiation use.Conclusions:PHC is associated with better survival outcomes than PBTC, with mFOLFIRINOX outperforming gem/nab-paclitaxel in both subtypes. LCA highlights heterogeneous patient subgroups, suggesting opportunities for personalized treatment strategies in PDAC management.
背景：胰腺导管腺癌（PDAC）的生存结局因肿瘤位置而异，胰头癌（PHC）与胰体尾癌（PBTC）在预后和治疗反应上存在差异。本研究探讨了接受标准化疗方案的PDAC患者肿瘤位置与生存结局之间的相关性。 方法：对休斯顿卫理公会尼尔癌症中心2015年1月至2024年5月期间确诊的604例PDAC患者（400例PHC，204例PBTC）进行回顾性分析。患者接受mFOLFIRINOX或吉西他滨/白蛋白结合型紫杉醇作为一线治疗。从电子病历中提取临床数据，包括人口统计学特征、肿瘤分期、治疗方式和分子谱。采用Kaplan-Meier分析和Cox比例风险模型评估总生存期（OS）和无进展生存期（PFS）。通过潜在类别分析（LCA）根据共享的临床、人口统计学和生存特征识别患者亚组。 结果：与PBTC患者相比，PHC患者的中位OS（12个月 vs. 9个月，p=0.012）和PFS（8个月 vs. 5个月，p=0.0008）更优。在两种亚型中，mFOLFIRINOX方案的OS均显著长于吉西他滨/白蛋白结合型紫杉醇方案（PHC：18.8个月 vs. 12.7个月，p<0.0001；PBTC：14个月 vs. 6个月，p=0.011）。LCA揭示了不同的患者集群：在PHC中，以根治为目的的集群（中位OS > 24个月）与姑息治疗集群（<6个月）形成对比；在PBTC中，积极治疗集群（中位OS > 18个月）与有限治疗集群（<6个月）存在差异。集群差异与治疗强度、分期和放疗使用相关。 结论：PHC患者的生存结局优于PBTC患者，且mFOLFIRINOX方案在两种亚型中的疗效均优于吉西他滨/白蛋白结合型紫杉醇方案。LCA揭示了异质性患者亚组，提示在PDAC管理中实施个体化治疗策略的可能性。
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