Natural History and Treatment Trends in Pancreatic Cancer Subtypes
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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.
KeywordsPancreatic cancer subtypes Pancreatic adenocarcinoma Neuroendocrine tumors Mucinous neoplasms
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.
- 6.Fesinmeyer MD, Austin MA, Li CI, Roos AJ De, Bowen DJ. Differences in Survival by Histologic Type of Pancreatic Cancer Differences in Survival by Histologic Type of Pancreatic Cancer. 2005;14(July):1766–1773.Google Scholar
- 7.Kloppel G, Solcia E, Longnecker DS, Capella C, Sobin LH. Histological Typing of Tumours of the Exocrine Pancreas. Vol 49.; 1996.Google Scholar
- 8.Paniccia A, Hosokawa PW, Schulick RD, Henderson W, Kaplan J, Gajdos C. A matched-cohort analysis of 192 pancreatic anaplastic carcinomas and 960 pancreatic adenocarcinomas: A 13-year North American experience using the National Cancer Data Base (NCDB). Surg (United States). 2016;160(2):281–292.Google Scholar
- 11.Shubert CR, Bergquist JR, Groeschl RT, Habermann EB, Wilson PM, Truty MJ, Smoot RL, Kendrick ML, Nagorney DM, Farnell MB. Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: An intention to treat analysis of the National Cancer Database. Surg (United States). 2016;160(4):1080–1096.Google Scholar
- 20.Crippa S, Salvia R, Warshaw AL, Domínguez I, Bassi C, Falconi M, Thayer SP, Zamboni G, Lauwers GY, Mino-Kenudson M, Capelli P, Pederzoli P, Del Castillo CF. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: Lessons from 163 resected patients. Ann Surg. 2008;247(4):571–579.CrossRefGoogle Scholar
- 25.Nguyen D, Dawson D, Hines J, Reber H, Donahue TR. Mucinous Cystic Neoplasms of the Pancreas : Are We Overestimating Malignant Potential ? Am Surg. 2014;80:915–919.Google Scholar
- 26.Rodriguez JR, Salvia R, Crippa S, Warshaw AL, Bassi C, Falconi M, Thayer SP, Lauwers GY, Capelli P, Mino-Kenudson M, Razo O, McGrath D, Pederzoli P, Fernández-Del Castillo C. Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology. 2007;133(1):72–9; quiz 309-10.CrossRefGoogle Scholar
- 27.Tanaka M, Fernández-Del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–197.CrossRefGoogle Scholar
- 30.Brown H a, Dotto J, Robert M, Salem RR. Squamous Cell Carcinoma of the Pancreas. 2005;39(10):915–919.Google Scholar
- 37.Kim JY, Song JS, Park H, Byun JH, Song K, Hong S. Primary Mesenchymal Tumors of the Pancreas. 2014;43(6):959–968.Google Scholar
- 38.Dai G, Huang L, Du Y, Yang L, Yu P. Solid pseudopapillary neoplasms of the pancreas : clinical analysis of 45 cases. 2015;8(9):11400–11406.Google Scholar
- 43.Yachida S, Vakiani E, White CM, Zhong Y, Saunders T, Morgan R, de Wilde RF, Maitra A, Hicks J, DeMarzo AM, Shi C, Sharma R, Laheru D, Edil BH, Wolfgang CL, Schulick RD, Hruban RH, Tang LH, Klimstra DS, Iacobuzio-Donahue CA. Small Cell and Large Cell Neuroendocrine Carcinomas of the Pancreas Are Genetically Similar and Distinct from Well- differentiated Pancreatic Neuroendocrine Tumors. Am J Surg Pathol. 2012;36(2):173–184.CrossRefGoogle Scholar
- 46.Ogbonna OH, Garcon MC, Syrigos KN, Saif MW. Mixed acinar-neuroendocrine carcinoma of the pancreas with neuroendocrine predominance. Case Rep Med. 2013;2013(grade 3):10–13.Google Scholar
- 48.Kyriazi MA, Arkadopoulos N, Stafyla VK, Yiallourou AI, Dafnios N, Theodosopoulos T, Kairi-Vassilatou E, Smyrniotis V. Mixed acinar-endocrine carcinoma of the pancreas: A case report and review of the literature. Cases J. 2009;2(4):1–5.Google Scholar
- 49.Boman FT, Carneiro F, Hruban RH TN. WHO Classification of Tumours of the Digestive System, 4th edn. Fr IARC. 2010.Google Scholar
- 50.Ferrone CR, Pieretti-Vanmarcke R, Bloom JP, Zheng H, Szymonifka J, Wargo JA, Thayer SP, Lauwers GY, Deshpande V, Mino-Kenudson M, Fernández-del Castillo C, Lillemoe KD, Warshaw AL. Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery. 2012;152(3 Suppl 1):S43–9.CrossRefGoogle Scholar
- 54.Sho M, Murakami Y, Motoi F, Satoi S, Matsumoto I, Kawai M, Honda G, Uemura K, Yanagimoto H, Kurata M, Fukumoto T, Akahori T, Kinoshita S, Nagai M, Nishiwada S, Unno M, Yamaue H, Nakajima Y. Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: A multicenter study on 822 patients. J Gastroenterol. 2015;50(6):694–702.CrossRefGoogle Scholar
- 57.Rutter CE, Park HS, Corso CD, Lester-Coll NH, Mancini BR, Yeboa DN, Johung KL. Addition of radiotherapy to adjuvant chemotherapy is associated with improved overall survival in resected pancreatic adenocarcinoma: An analysis of the National Cancer Data Base. Cancer. 2015;121(23):4141–4149.CrossRefGoogle Scholar
- 58.Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, Zahurak ML, Dooley WC, Coleman JA, Sauter PK, Pitt HA, Lilltemoe KD, Cameron JL. Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival: A prospective, single-institution experience. Ann Surg. 1997;225(5):621–636.CrossRefGoogle Scholar
- 71.Boffa DJ, Rosen JE, Mallin K, Loomis A, Gay G, Palis B, Thoburn K, Gress D, McKellar DP, Shulman LN, Facktor MA, Winchester DP. Using the National Cancer Database for Outcomes Research. JAMA Oncol. 2017.Google Scholar
- 72.Lerro CC, Robbins AS, Phillips JL, Stewart AK. Comparison of cases captured in the national cancer data base with those in population-based central cancer registries. Ann Surg Oncol. 2013.Google Scholar