Institutional experience with pancreatic head versus body/tail cancer: A comparison of treatment outcomes.

e16436Background: Pancreatic ductal adenocarcinoma (PDAC) continues to rise globally, with a poor prognosis and devastating outcomes. This study aims to compare treatment response outcomes in patients with PDAC located in the head of the pancreas (PHAC) versus the body/tail (PBTAC) of the pancreas. Methods: We retrospectively reviewed the medical records of patients at Houston Methodist Neal Cancer Center (HMNCC) and its affiliated community hospitals from January 2015 to December 2024. Patients were categorized into two groups based on the anatomical location of the tumor: PHAC and PBTAC. Treatment regimens included either the folinic acid, fluorouracil, irinotecan, oxaliplatin (FOLFIRINOX) regimen or gemcitabine-based chemotherapy. Machine learning algorithms powered by artificial intelligence (AI) were employed to classify patients into clusters based on genetic mutations. The primary endpoints were progression-free survival (PFS) and overall survival (OS), analyzed according to tumor location. Results: Out of 2,103 patients screened, 600 patients met the eligibility criteria for analysis. Among them, 397 (66.1 had PHAC and 203 (33.8 had PBTAC. Genetic mutation analysis revealed no significant differences between the two groups for most mutations, except for KRAS and TP53 mutations, which were more common in PHAC patients (10.7 respectively) compared to PBTAC patients (5.2.1 respectively). For PHAC, two genetic clusters were identified based on mutation patterns. Notably, cluster 2 contained 38 (6.2 patients with a KRAS mutation and 24 (3.9 with a TP53 mutation. For PBTAC, two clusters were also identified, with cluster 1 showing higher mutation rates in KRAS (27 patients, 4.42 and TP53 (14 patients, 2.29. Regarding treatment, 243 PHAC patients (40.5 received FOLFIRINOX, and 154 (25.6 received gemcitabine-based therapy. In the PBTAC group, 108 patients (18 received FOLFIRINOX, and 95 (15.8 received gemcitabine-based therapy. The median PFS for PHAC patients was 10 months, compared to 8 months for PBTAC patients (P = 0.010). Similarly, the median OS for PHAC patients was 12 months, while it was 8 months for PBTAC patients (P = 0.018). Conclusions: This study demonstrates that patients with PHAC exhibit significantly better survival outcomes than those with PBTAC. These findings suggest that the anatomical location of the tumor may influence treatment response and prognosis. Further prospective studies are necessary to validate these results and explore potential predictive factors for improved patient outcomes.