{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:42:56Z","timestamp":1792582976305,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical and molecular features of pancreatic adenocarcinoma (PDAC) according to involved metastatic sites have not been well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We used the Foundry platform to query information for patients with metastatic PDAC at MD Anderson Cancer Center. Involved metastatic sites were extracted using natural language processing from imaging reports and verified by chart reviews. Overall survival (OS) and next generation sequencing (NGS) data were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In a cohort of 1,095 patients (median overall survival [OS]: 22.8 months), lung-only metastasis was associated with longer median OS (57.6 months, p&amp;lt;0.0001). Patients with metastases not involving the liver had OS of 41.3 months, while liver-only (19.5 months) and multiple sites including liver (19.3 months) had the poorest survival. TP53 mutation rates were higher in liver-involved groups (84\u201385%) versus lung-only (73%) and non-liver metastases (67%, p&amp;lt;0.0001). Lower rates of GNAS mutations were detected in liver-only (5%) and liver-involved (2%) cases, higher in lung-only (8%) and non-liver (10%, p&amp;lt;0.01). The frequency of KRAS mutation and mutant allele distribution were not significantly different in tissue based NGS. However, in liquid biopsy analysis (n\u2009=\u2009240), lung-only metastasis showed the lowest mutation detection (50%), TP53 (23%) and KRAS (10%), compared to liver-only detection rates of 65%, 46%, and 52% respectively (p values: 0.009, 0.02, &amp;lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with PDAC without liver metastasis have significantly improved OS and lower rates of TP53 mutation. Patients with lung-only metastasis had longer OS, a lower liquid-biopsy positivity rate, and a lower rate of KRAS detection by liquid biopsy; because liquid biopsy may under-detect KRAS in lung-only disease, tumor-tissue sequencing should be prioritized in these patients as KRAS-directed therapies emerge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyag423","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:40:36Z","timestamp":1792496436000},"source":"Crossref","is-referenced-by-count":0,"title":["Site-Specific Outcomes and Genomics in Metastatic Pancreatic Ductal Adenocarcinoma"],"prefix":"10.1093","author":[{"given":"Mahmoud","family":"Yousef","sequence":"first","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saikat","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sali","family":"Albarouki","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Department of Gastroenterology and Hepatology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elhariri","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastroenterology, Hepatology and Nutrition, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guglielmo","family":"Vetere","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacha","family":"El Khoury","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Fanaeian","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman","family":"Yousef","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwathy","family":"Balachandran Pillai","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Alfaro-Munoz","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Knafl","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Genomic Medicine, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Roy","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Enterprise Data Engineering and Analytics, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W","family":"Hurd","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Sheikh Ahmed Center for Pancreatic Cancer Research, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G","family":"Smaglo","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A","family":"Wolff","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubham","family":"Pant","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Willis","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Huey","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Overman","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Lopez","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Chen","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan B","family":"Ludmir","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Radiation Oncology, , Houston, TX,","place":["USA"]},{"name":"The University of Texas MD Anderson Cancer Center Department of Biostatistics, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene J","family":"Koay","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Radiation Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A","family":"Snyder","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Wei","family":"Tzeng","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P","family":"Kim","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naruhiko","family":"Ikoma","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica E","family":"Maxwell","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huamin","family":"Wang","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Anatomical Pathology, Division of Pathology\/Lab Medicine, , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirban","family":"Maitra","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, , Houston, TX,","place":["USA"]},{"name":"The University of Texas MD Anderson Cancer Center Department of Anatomical Pathology, Division of Pathology\/Lab Medicine, , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew H G","family":"Katz","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Molecular and Cellular Oncology, Division of Discovery Science, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoqiang","family":"Ying","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Molecular and Cellular Oncology, Division of Discovery Science, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Paul","family":"Shen","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Zhao","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,20]]},"container-title":["The 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