AbstractIntroductionPancreatic ductal adenocarcinoma (PDAC) is a genetically heterogeneous disease often diagnosed with synchronous metastatic disease involving the liver. Tumors with extra‐abdominal spread that bypass the liver are thought to represent a unique molecular subgroup and those with isolated pulmonary metastatic disease are thought to have a more favorable clinical phenotype.MethodWe conducted a retrospective review of patients with pathologically confirmed PDAC treated between the years 2007 and 2020 at a Scripps Health hospital. The final study sample (N= 205) included patients with isolated pulmonary metastasis (IL), isolated liver metastasis or synchronous liver and lung metastasis (LL), or metastasis to any site other than the liver or lung (NLL). Primary endpoint was overall survival (OS). Progression‐free survival (PFS) and recurrence‐free survival (RFS) were analyzed as secondary endpoints. Each survival outcome was analyzed using Cox proportional hazards tests.ResultsNo statistically significant differences were seen between the three groups inOS,PFS,orRFS. MedianOSfor theILgroup was 561 days, 341 days for theLLgroup, and 441 days for theNLLgroup. MedianRFSwas 748 days for theILgroup, 574 days for theLLgroup, and 545 days for theNLLgroup. MedianPFSwas 307 for theILgroup, 236 for theLLgroup, and 265 for theNLLgroup. When comparing only theILandLLgroups, a statistically significant difference inOSwas seen favoring theILgroup (HR1.59LLvsIL[ref],CI1.04–2.41,p= 0.031)ConclusionThough statistically significant differences in survival outcomes were not seen in our population, there was a trend toward improved survival for patients with isolated lung metastases. When comparing only the IL to LL group, statistically significant overall survival favoring the IL group was seen. These findings highlight a potential prognostic indicator of metastatic PDAC.