The impact of tumour location on resectability and survival in pancreatic ductal adenocarcinoma: a national registry study

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Abstract Introduction Prognosis in pancreatic ductal adenocarcinoma (PDAC) remains poor. Tumour location may affect clinical outcomes, including the ability to resect, patterns of spread, and overall survival.This study aimed to evaluate differences in survival according to location for all stages of PDAC. Methods The Swedish pancreatic and periampullary cancer registry was used to identify patients diagnosed between 2014–2023. Group differences were assessed using Kruskal-Wallis test for continuous variables and Pearson Chi-Square test for categorical variables. The hazard ratio (HR) for each tumor location was calculated using Cox regression, adjusted for age and sex. Results The final cohort included 10 763 patients with PDAC in the head (n = 6419), body (n = 2509) or tail (n = 1835) of the pancreas. Patients with tail tumours were significantly younger (median age: head 73 versus body 73 versus tail 71 years, P < 0.001). The relative rate of resection was highest for head tumours, followed by tail and body (29.8% versus 9.5% versus 13.6%, P < 0.001). Metastatic disease at diagnosis was more common in body and tail tumours (39.6% versus 69.1% versus 78.2%, P < 0.001). In multivariable Cox analysis, compared with tumours in the head, tumours in the body (HR 1.41, 95% c.i. 1.35–1.48, P < 0.001) and tail (HR 1.40, 95% c.i. 1.33–1.48, P < 0.001) were independently associated with worse survival. Discussion PDAC in the body and tail of the pancreas was associated with more advanced stage at diagnosis and worse survival than head tumors. The younger age at diagnosis may indicate the possibility of biological differences beyond delayed detection alone.

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