Journal of Gastrointestinal Surgery

, Volume 23, Issue 4, pp 768–778 | Cite as

Natural History and Treatment Trends in Pancreatic Cancer Subtypes

  • Courtney J. Pokrzywa
  • Daniel E. Abbott
  • Kristina A. Matkowskyj
  • Sean M. Ronnekleiv-Kelly
  • Emily R. Winslow
  • Sharon M. Weber
  • Alexander V. FisherEmail author
Original Article



While pancreatic ductal adenocarcinoma is the most common form of pancreatic cancer, many other histologic forms of pancreatic cancer are also recognized. These histologic variants portray unique characteristics in terms of patient demographics, tumor behavior, survival, and responsiveness to treatments.

Materials and Methods

Patients who underwent surgical resection of the pancreas for non-metastatic, invasive pancreatic cancer between 2004 and 2014 were selected from the National Cancer Data Base and categorized by histologic variant according to WHO classification guidelines. Patient demographics, tumor variables, treatment characteristics, and survival were compared between histologic groups and subgroups.


A total of 57,804 patients met inclusion and exclusion criteria and were grouped into eight major histologic categories. Survival analysis by the histologic group showed median overall survival of 20.2 months for ductal adenocarcinoma, 20.5 months for squamous cell carcinoma, 26.8 months for mixed acinar-neuroendocrine carcinomas, 52.6 months for cystic mucinous neoplasms with an associated invasive carcinoma, 67.5 months for acinar cell carcinoma, and 69.3 months for mesenchymal tumors. Median survival was not reached for neuroendocrine tumors and solid-pseudopapillary neoplasms, with 5-year overall survival rates of 84% and 97% respectively.


Rare subtypes of pancreatic cancer present unique clinicopathologic characteristics and display distinct tumor biologies. This study presents data on demographic, prognostic, treatment, and survival outcomes between rare forms of pancreatic neoplasms in order to aid understanding of the natural history and behavior of these neoplasms, with the hope of serving as a reference in clinical decision-making and ability to provide accurate prognostic information to patients.


Pancreatic cancer subtypes Pancreatic adenocarcinoma Neuroendocrine tumors Mucinous neoplasms 


Authors’ Contributions

Courtney J. Pokrzywa made substantial contribution to the study conception and design, data analysis and interpretation, and manuscript drafting and revision. Daniel E. Abbott made substantial contribution to the study conception and design, data analysis and interpretation, and manuscript drafting and revision. Kristina A. Matkowskyj made substantial contribution to the study conception and design, data analysis and interpretation, and manuscript drafting and revision. Sean Ronnekleiv-Kelly made substantial contribution to the study design, data interpretation, and manuscript revision. Emily R. Winslow made substantial contribution to the study design, data interpretation, and manuscript revision. Sharon M. Weber made substantial contribution to the study design, data interpretation, and manuscript revision. Alexander V. Fisher made substantial contribution to the study conception and design, data analysis and interpretation, and manuscript drafting and revision. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

11605_2019_4113_MOESM1_ESM.docx (35 kb)
ESM 1 (DOCX 35 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of SurgeryColumbia University Medical CenterNew YorkUSA
  2. 2.Department of SurgeryUniversity of WisconsinMadisonUSA
  3. 3.Department of PathologyUniversity of WisconsinMadisonUSA

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