Characteristics and outcomes of adenosquamous carcinoma of the pancreas.

Abstract

311 Background: Adenosquamous carcinoma of the pancreas (ASCAP) is a rare pancreatic malignancy variant reported to have a worse prognosis than adenocarcinoma of the pancreas (ACP). Most reports demonstrate a survival rate of less than two years. This study was undertaken to characterize this subtype in the context of a contemporary ACP cohort. Methods: This retrospective analysis included all patients who underwent definitive pancreatic cancer resection at the University of Florida from 2001 to 2011. Central pathology review of suspected ASCAP cases was undertaken. Patient characteristics, tumor features, treatment, and outcomes were collected with t-test analysis for differences. Results: Eight of 237 patients (3.3%) were histologically confirmed as ASCAP. Differences between the ASCAP and ACP cohorts are listed in the Table. ASCAP patients were similar to patients with ACP with no differences in presentation, symptoms or reported tumor markers including CA19-9, CEA, or hypercalcemia. However, ASCAP patients were slightly older, smoked less, and had more involvement of the body and tail. None (0/8) of the ASCAP diagnoses were identified on fine needle aspiration, only surgical specimen review. Post-operative therapy was inconsistently provided to the ASCAP patient population. With a median f/u of 2.9 years, 31% of ACP and 37% of ASACP patients are alive with median overall survival favoring patients with ACP (0.6 vs. 1.7 years; p<0.006). Conclusions: In a contemporary cohort, ASCAP remains a rare malignancy with a relatively worse prognosis than ACP. Diagnostic biopsy may be non-confirmatory for ASCAP and may lead to under-reporting. Aggressive surgical resection is curative for a subset of ASCAP patients, but overall survival remains poor. Further investigation into the role of adjuvant therapy and risk factor modification for this variant may be valuable. [Table: see text]