Lung-Only Metastases Tied to Better Survival, Unique Profile

TOPLINE:

In a retrospective analysis, patients with lung-only metastatic pancreatic ductal adenocarcinoma (PDAC) demonstrated a median overall survival of 28.7 months compared to 12.8 months for those with metastases at other sites. These patients were predominantly women and presented with a low tumour mutational load.

METHODOLOGY:

Researchers analysed 1012 patients with metastatic PDAC, including 109 (11%) with lung-only metastases, 506 (50%) with liver-only metastases, 94 (9%) with peritoneal-only metastases, and 303 (30%) with metastases at other or multiple sites, at a French academic centre from 2010 to 2024.
Overall, 42% of patients in the lung-only group vs 69% of those in the other group had synchronous metastases (P < .001), 63% of those in the lung-only group vs 46% of those in the other group were women (P = .005), and those in the lung-only group were older at metastatic diagnosis (median age, 66.2 vs 63.0 years; P = .0096). However, all patients received standard-of-care systemic chemotherapy for metastatic PDAC.
Molecular profiling was done using tumour tissue or circulating cell-free DNA, whichever was available, examining mutations in KRAS, TP53, and other genes.
Outcomes included tumour mutational burden, overall survival, progression-free survival, and the impact of local treatments in patients with metastatic PDAC.

TAKEAWAY:

Molecular analysis revealed a lower detection of KRAS mutations (59% vs 80%) and TP53 mutations (57% vs 72%; P < .05 for both) in patients with lung-only metastases vs other patients in the case of liquid biopsy, although no differences were observed in tumour tissue analysis. The median tumour mutational burden was lower in the lung-only group than in the other group (P = .03).
The disease control rate was higher in the lung-only group than in the other group (84% vs 72%; P < .05). Those in the lung-only group vs other group exhibited significantly longer median overall survival (28.7 vs 12.8 months) and progression-free survival (10.6 vs 6.1 months; P < .0001 for both).
Patients with lung-only metastases who underwent locoregional treatment had a median overall survival of 81.3 months from the initial diagnosis compared to 51.3 months for other patients who did not (P = .02).
Multivariate analysis confirmed lung-only metastases at diagnosis as an independent favourable factor for better overall survival (adjusted hazard ratio, 0.40; P < .0001).

IN PRACTICE:

“This retrospective cohort highlights the better prognosis of lung-only metastases PDAC patients in a real-world setting and the potential benefit of local treatments,” the authors wrote, adding that “these patients should be considered quite differently from the majority of metastatic pancreatic cancer patients.”

SOURCE:

This study was led by Alice Boiléve and Léa Mercier, Gustave Roussy, Département de Médecine Oncologique, Paris, France. It was published online on January 09, 2026, in the European Journal of Cancer.

LIMITATIONS:

The retrospective design resulted in missing data, although this was partially offset by the large cohort size. The median overall survival observed in this study was longer than that reported in previous studies. Additionally, the extensive use of liquid biopsy for molecular profiling contributed less for patients with lung-only metastases, potentially affecting the completeness of molecular characterisation.

DISCLOSURES:

No funding information was reported for this study. The STING trial was supported by Prism-National Precision Medicine Center in Oncology funded by the France 2030 program and the French National Research Agency. Four authors reported having commercial ties with Merck, Amgen, and various other sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.