Comparative outcomes of pancreatic versus duodenal adenocarcinoma: A National Cancer Database analysis.

Abstract

686 Background: Pancreatic and duodenal adenocarcinomas share anatomic proximity but may differ in tumor biology, treatment patterns, and outcomes. Limited large-scale comparative data exist. We utilized the National Cancer Database (NCDB) to examine clinicopathologic features and survival outcomes between these two malignancies. Methods: We identified patients diagnosed with pancreatic (n=53,177) or duodenal (n=4,765) adenocarcinoma in the NCDB. Demographic, clinical, and treatment variables were compared using chi-square and Wilcoxon rank-sum tests. Survival was assessed with Kaplan–Meier analysis and log-rank testing, stratified by stage and surgical resection. Results: Duodenal cancer patients were slightly older (median 70 vs. 68 years, p<0.001), more often male (54.5% vs. 51.3%, p<0.001), and more likely Black (17.4% vs. 11.2%, p<0.001). Duodenal primaries also presented with more advanced T-stage (T3-4: 66.2% vs. 52.7%, p<0.001), increased node + disease, (N+: 34.1% vs. 30.9%, p<0.001) higher metastatic rates (M1: 25.5% vs. 20.7%, p<0.001), and received less multimodality therapy (48.6% vs. 66%, p<0.001). Surgical resection was less common in duodenal cancers (37.2% vs. 41.1%, p<0.001). Among surgical patients (n=23,619), duodenal adenocarcinoma demonstrated increased R0 resections (91.5% vs. 77.4%, p<0.001) and lower 90-day mortality (8.3% vs. 6.9%, p=0.02). Median overall survival (OS) for patients with non-metastatic disease favored duodenum in both node negative (24.2 vs. 15.9 months; 5-year OS 34% vs. 15%, p<0.001) and node positive (12.6 vs 11.1 months; 5-year OS 19 vs. 9%). For patients with metastatic disease, survival was poor for both, though modestly longer for duodenum (median OS 5.5 vs. 4.9 months; p≤0.001). Conclusions: This large NCDB analysis demonstrates that duodenal adenocarcinoma presents with more aggressive features and yet achieves significantly better survival than pancreatic adenocarcinoma across all stages. Among the surgical patients, there was a higher likelihood of achieving R0 resections and lower 90-day mortality. These findings highlight key biological and clinical distinctions that warrant tailored therapeutic strategies.