Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2022; 14(3): 716-723
Published online Mar 15, 2022. doi: 10.4251/wjgo.v14.i3.716
Pancreatic head vs pancreatic body/tail cancer: Are they different?
Kai Sun, Charisma Mylavarapu, Aubrey Crenshaw, Yuqi Zhang, Enshuo Hsu, Jiaqiong Xu, Marilyn Niravath, Stephen L Jones, Adriana Ordonez, Maen Abdelrahim
Kai Sun, Maen Abdelrahim, Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX 77030, United States
Charisma Mylavarapu, Aubrey Crenshaw, Yuqi Zhang, Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, United States
Enshuo Hsu, Jiaqiong Xu, Marilyn Niravath, Stephen L Jones, Adriana Ordonez, Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX 77030, United States
Author contributions: Sun K and Abdelrahim M designed the study; Sun K, Mylavarapu C, Crenshaw A and Zhang Y performed chart review; Hsu E, Xu JQ and Ordonez A analyzed the data; Niravath M and Jones SL performed bioinformatics and retrieved patient records; Sun K and Abdelrahim M wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Houston Methodist Hospital Institutional Review Board, Approval No. MOD00002232.
Informed consent statement: Informed consent from patients was waived.
Conflict-of-interest statement: There is no conflict-of-interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ksun2@houstonmethodist.org.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maen Abdelrahim, BPharm, MD, PhD, Assistant Professor, Director, Houston Methodist Cancer Center, Houston Methodist Hospital, 6445 Main Street, Houston, TX 77030, United States. mabdelrahim@houstonmethodist.org
Received: September 29, 2021
Peer-review started: September 29, 2021
First decision: November 7, 2021
Revised: November 16, 2021
Accepted: January 27, 2022
Article in press: January 27, 2022
Published online: March 15, 2022
Abstract
BACKGROUND

The impact of pancreatic tumor location on patient survival has been studied in large national data-based analyses which yielded controversial results.

AIM

To explore if pancreatic head cancer (PHC) and pancreatic body/tail cancer (PBTC) have different overall survival (OS), molecular signature and response to chemotherapy.

METHODS

We retrospectively queried patient records from July 2016 to June 2020 in our institution. Patient demographics, cancer stage on diagnosis, tumor location, somatic mutations, treatment, and survival are recorded and analyzed. A test is considered statistically significant if the P value was < 0.05.

RESULTS

We reviewed 101 patients with complete records, among which 67 (66.34%) were PHC and 34 (33.66%) were PBTC. More PHC were diagnosed at younger age [61.49 vs 68.97, P = 0.010], earlier stages (P = 0.006) and underwent surgical resection (P = 0.025). There were no significant differences among all mutations and pathways studied except for TP53 mutations (37.0% in PHC vs 70.0% in PBTC, P = 0.03). OS was not statistically different between PHC and PBTC (P = 0.636) in the overall population and in subgroups according to surgical resection status or stages. In terms of response to chemotherapy, chemotherapy regimens (FOLFIRINOX-based vs gemcitabine-based) didn’t impact disease free interval in those who had surgical resection in either PHC (P = 0.546) or PBTC (P = 0.654), or the duration of response to first line palliative treatment in those with advanced disease in PHC (P = 0.915) or PBTC (P = 0.524).

CONCLUSION

Even though PHC and PBTC have similar poor OS and response to chemotherapy, the different presentations and molecular profiles indicate they are different diseases. Utilization of molecular profiling to develop targeted therapy for individualization of treatment is needed.

Keywords: Pancreatic cancer, Tumor location, Molecular profiling, Survival, Response to chemotherapy

Core Tip: The study is a retrospective study of the impact of pancreatic cancer location on survival, molecular profiling and response to chemotherapy among patients who were diagnosed with pancreatic cancer in our institution. Even though there was no significant difference in survival or response to chemotherapy between pancreatic head and pancreatic body/tail cancer, we did observe a trend of long-term survival in stage I/II pancreatic tail patients who underwent surgical resection. TP53 mutations were significantly more in pancreatic body/tail cancer than that in pancreatic head cancer and we propose that gemcitabine-based chemotherapy should be considered in those patients.