Patient factors and survival outcomes of pancreatic signet cell carcinoma: A comprehensive review and analysis.

Abstract

608 Background: Pancreatic signet cell carcinoma is an aggressive, rare subtype of pancreatic adenocarcinoma that constitutes less than 1% of all pancreatic cancers. This subtype can manifest as solitary cells or a cluster within the background of pancreatitis, often leading to an incorrect diagnosis during biopsies. The rarity and challenges associated with its diagnosis significantly impact its poor prognosis. With an average age of diagnosis of 67.3 years and a median life expectancy of 12.6 months, there exists a lack of information on the disparities that exist in these patients and how patient demographics contribute to differences in survival outcomes. Methods: We used the National Cancer Database to identify patients diagnosed with pancreatic signet ring cell carcinoma (ICD-O-3 histology code 8490) between 2004-2019 (N=1746). Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p<0.05. Results: When analyzing insurance status, patients with private insurance had a statistically improved survival outcome (14.3 months) compared to those with Medicare (11.3 months), Medicaid (9.2 months) and without insurance (11.8 months) (p<0.05). Patients with private insurance had fewer positive regional lymph nodes (73), lower grade/differentiation (5.80) and an average tumor size of 444.40 millimeters. Patients treated at academic research programs had a statistically better survival outcome (15.1 months) compared to patients treated at comprehensive community (10.4 months) and integrated network (9.1 months) programs (p<0.001). Surgical treatment had statistically improved survival outcomes compared to non-surgical treatment (p<0.001) with the majority of these procedures being a partial pancreatectomy and duodenectomy with a partial gastrectomy. More patients received surgical intervention at academic research programs (p<0.001), and patients with private insurance predominately attended academic research programs (p<0.001). Conclusions: Factors associated with increased survival outcomes include insurance status, positive regional lymph nodes, grade/differentiation, treatment facility type and surgical intervention. These findings make a valuable contribution to the ongoing research on disparities affecting survival in patients with pancreatic signet cell carcinoma.