Pancreatic Squamous Cell Carcinoma Research Articles

375P Landscape of pancreatic squamous cell carcinoma: A Polish multicenter study

375P Landscape of pancreatic squamous cell carcinoma: A Polish multicenter study

Pure squamous cell carcinoma of primary pancreatic origin

Introduction. Primary, ?pure? squamous cell carcinoma (SCC) is an exceptionally rare pancreatic malignancy that has been described in sporadic case reports. The appearance of this rare entity created a diagnostic dilemma for us, therefore, in this case report, we are focused on the radiological detection and characterization, pathogenesis, and therapeutic options of pure pancreatic SCC. Case outline. In an 80-year-old female patient, a partially necrotic mass in the tail of the pancreas was detected by computed tomography, which is the rarest localization of this tumor. On the performed imaging, the tumor showed predominantly malignant features with a surprising definitive histopathological diagnosis in the direction of pure SCC. Distal pancreatectomy with splenectomy was performed because of the infiltration of lienal vascular structures. Conclusion. Due to the very aggressive form of this tumor and poor prognosis, early detection, risk factors control, genetic burden, and optimization of surgical and therapeutic management can improve the quality of life and prolong the overall survival period.

A case of pancreatic squamous cell carcinoma metastasizing along the puncture site 7 days after laparoscopic surgery

A case of pancreatic squamous cell carcinoma metastasizing along the puncture site 7 days after laparoscopic surgery

Primary squamous cell carcinoma of the pancreas: an update on a rare neoplasm from the SEER database.

Pancreatic squamous cell carcinoma is a rare type of pancreatic cancer of ductal origin, composing an estimated 0.5 - 5% of pancreatic ductal malignancies. As a result, epidemiology, treatment options, and associated outcomes are poorly understood and understudied. Our aim was two-fold: to evaluate demographic trends and analyze overall survival (OS) associated with different treatment modalities for this rare malignancy. Patients with pancreatic squamous cell carcinoma diagnosed between 1992 and 2019 were eligible and reviewed utilizing the Surveillance, Epidemiology, and End Results Registry (SEER) database. Data was analyzed using SPSS and python packages lifelines and pandas. Variables of interest included stage at diagnosis as well as the receipt of surgery, radiotherapy, and/or chemotherapy. Five-year OS curves were analyzed using Kaplan-Meier probability stratified by treatment modality. Of 342 cases of pancreatic squamous cell carcinoma, 170 (49.7%) were females and 172 (50.3%) were males. 72 (21.1%) of patients received radiotherapy, 123 (35.9%) patients received chemotherapy, and 47 (13.7%) received surgery. Patients who were diagnosed under the age of 50 had prolonged survival time compared to those diagnosed over the age of 50 (12 vs 8 months, respectively, p < 0.001). This trend was evident despite the lack of a significant association between age at diagnosis and presence of metastases (p = 0.524). The median OS was 3 months for the entire cohort and there was a significant difference in median survival time noted across treatment modalities: OS was prolonged in those receiving surgery compared to those receiving chemotherapy or radiotherapy alone (30 vs 2 months, respectively, (p<0.001)). Receipt of radiotherapy was not associated with a significant difference in OS compared to those who did not receive radiotherapy. Pancreatic squamous cell carcinoma is a rare subtype of pancreatic cancer and typically portends a poor prognosis. As demonstrated by our study, surgery offers prolonged overall survival compared to other treatment modalities. Age at diagnosis and presence of metastatic disease are also important prognostic factors likely related to patients' ability to tolerate surgery or physician willingness to offer surgery. Given the importance of surgery on outcomes, it may be reasonable to offer it in the oligometastatic setting in patients who are otherwise a good candidate. Future research on larger cohorts is warranted to investigate the role that modality selection plays in overall survival rates in this understudied malignancy.

S2116 Rare Primary Pancreatic Squamous Cell Carcinoma Presenting as Duodenal Obstruction

S2116 Rare Primary Pancreatic Squamous Cell Carcinoma Presenting as Duodenal Obstruction

Challenges in managing upper gastrointestinal bleeding secondary to primary squamous cell carcinoma of the pancreas: a case report and literature review

BackgroundPrimary pancreatic squamous cell carcinoma (SCC) is a rare type of pancreatic cancer, with an incidence of 5% of all pancreatic cancers. This condition is associated with a poor prognosis, and no optimal treatment has been established (Zhang et al. in Medicine (Baltim). 97:e12253, 2018).Case presentationA 56-year-old man presented to our hospital with upper gastrointestinal bleeding and new-onset diabetes mellitus. He had no other medical comorbidities, episodes of pancreatitis and symptoms secondary to pancreatic insufficiency. A computed tomography (CT) scan showed a 94 × 72 × 83 mm necrotic pancreatic body mass with gastric invasion and multiple liver metastases. Gastroscopy revealed deep ulcerations at the posterior wall of the stomach with an active slow ooze. Endoscopic ultrasound was performed with EUS guided biopsy, which confirmed poorly differentiated squamous carcinoma of the pancreas. The patient underwent palliative radiotherapy for recurrent upper gastrointestinal bleeding followed by palliative chemotherapy with gemcitabine and nab-paclitaxel. He was referred to dietitians and diabetes educators for the management of pancreatic exocrine and endocrine insufficiency before being referred to community palliative care upon discharge.ConclusionsThis is the first reported Australian case of pancreatic SCC presenting with upper gastrointestinal bleeding and new-onset diabetes mellitus. Patients with unresectable disease require a multidisciplinary approach to manage complications and improve symptom control. However, there are no standard treatment guidelines and future research is needed in this regard.

PAK4 kinase as a potential therapeutic target of the transcription factor p63-meditated squamous cell carcinomas of the pancreas.

This study was undertaken to better understand the pathogenesis of squamous cell carcinoma (SCC) of the pancreas and to determine if inhibiting the p21-activated kinase 4 (PAK4) activity could be used for treating pancreatic SCCs. Here are the context of the research and preliminary results: Although significant research has been done on adenocarcinoma of the pancreas, the current understanding of pancreatic SCCs remains limited, and there is no known cure for it. We established a mouse model of pancreatic SCCs by over-expressing the transcription factor p63 in the pancreatic ductal epithelial-specific manner. Our working hypothesis was that dysregulation of p63-mediate transcriptional networks can lead to the development of pancreatic SCCs. As the stability of p63 is regulated at the protein level by phosphorylation, we searched for kinase that stabilizes p63 and identified PAK4 kinase. Although previous studies have shown that PAK4 is frequently overexpressed in ductal adenocarcinoma of the pancreas, the involvement of PAK4 in the pathogenesis of pancreatic SCCs remained unclear. We have demonstrated that suppression of the PAK4 kinase activity by a small molecule inhibitor reduced p63 levels in cellular models of pancreatic SCCs, leading to the complete suppression of their proliferation in vitro. These results indicate that PAK4 kinase can serve as a novel therapeutic target for some pancreatic SCCs and that PAK4-mediated stabilization/upregulation of the transcription factor p63 can be the key molecular event underlying the pathogenesis of pancreatic SCCs. We will use our mouse models in future studies to determine if administration of the PAK4 inhibitor in vivo can be used as an effective therapy for the treatment and prevention of the development of this most dangerous cancer subtype in human cancers.

Pancreatic Adenosquamous Carcinoma: A Rare Pathological Subtype of Pancreatic Cancer.

Pancreatic adenosquamous carcinoma (PASC) is a rare pathological subtype of pancreatic cancer (PC), with a worse prognosis than pancreatic ductal adenocarcinoma (PDAC). Due to its rarity, our knowledge of PASC and its biological characteristics are limited. In this review, we provide an overview of the histogenesis, genetic features, diagnosis, treatment, and prognosis of PASC, as well as pancreatic squamous cell carcinoma (PSCC). The information provided here may help to clarify our understanding of PASC and provide useful avenues for further research on this disease.

Epidemiology, Treatment, and Outcome of Pancreatic Squamous Cell Carcinoma and Pancreatic Adenocarcinoma: A Propensity Score-Matching Analysis Based on SEER-Database.

Background: Pancreatic squamous cell carcinoma (PSCC) is a rare pancreatic malignancy compared to most common pancreatic adenocarcinoma (PAC). Aims: To analyze the prognostics factors of PSCC and compare PAC with PSCC in demographic patterns, clinicopathologic characteristics and treatment modalities. Methods: Data of PSCC and PAC patients from January 1, 2004 to December 31, 2015 were extracted from Surveillance, Epidemiology and End Results (SEER) database for case-control study. Kaplan-Meier method and Cox proportional hazards analysis were used in survival analysis. A 1:3 propensity-score matching (PSM) was performed to compare the overall survival (OS) and cancer specific survival (CSS) between PAC and PSCC in each variable. Results: PAC patients (n = 38 968) and PSCC patients (n = 124) were analyzed. After PSM, 372 PAC patients and 124 PSCC patients were obtained. PSCC tends to happen to elders, white and female with a predilection site of pancreatic head, followed by tail, then body. PSCC have a higher proportion to be poorly differentiated and metastatic when diagnosed. The prognosis of PSCC patients was significantly worse than PAC patients in both univariate and multivariate analyses. Surgery and chemotherapy were independent prognostic factors for PSCC. Conclusions: PSCC patients were identified associated with a worse prognosis than PAC patients. PSCC tend to be poorly differentiated and more easily to be metastatic. Surgery and chemotherapy may be effective therapies to improve the OS of PSCC significantly.

Primary Pancreatic Squamous Cell Carcinoma: An Incidental Diagnosis of a Rare Entity

Primary Squamous Cell Carcinoma (SCC) of pancreas is a non endocrine tumour showing ductal origin which accounts for approximately 0.5-2% of all malignant pancreatic tumours. Diagnosis is usually made by tissue sampling followed by comprehensive search for primary SCC elsewhere. Hereby, authors report a rare case of primary pancreatic SCC in a young female. A 46-year-old female with history of type 2 diabetes mellitus presented with abdominal pain radiating to back associated with biliary vomiting since five months. Laboratory investigations revealed mild anaemia, neutrophilic leucocytosis and elevated blood glucose. Carcinoembryonic Antigen (CEA) and Cancer Antigen 19-9 (CA 19-9) were within normal limits. Contrast-Enhanced Computed Tomography (CECT) (abdomen and pelvis) showed pancreatic atrophy, multiple stones in head and body along with a pseudocyst in tail of pancreas. Patient underwent triple phase Magnetic Resonance Imaging (MRI) with Magnetic Resonance Cholangiopancreatography (MRCP) which showed chronic pancreatitis with intraductal calculi in the head and distal body region with pseudocyst at tail region. Frey’s procedure was done and tissue sent in multiple pieces. Histopathology revealed features of infiltrating SCC in a background of atrophic pancreas. Immunohistochemistry for CK5/6, P63 and CEA was done for confirmation. It showed strong positivity for CK5/6 and P63, while CEA was negative. Final diagnosis of SCC of pancreas in a background of atrophic pancreas was rendered. Though pancreas is devoid of squamous cells, it is not uncommon to find squamous metaplasia of ductal epithelial cells secondary to chronic inflammation. In the present case, though clinical and radiological features points towards benign lesion, definite diagnosis as SCC is justified by histopathology and immunohistochemistry. Because of the rarity, diagnosis and treatment still remains a challenge.

Adenosquamous and squamous cell carcinoma of the pancreas: two histopathological variants of ductal adenocarcinoma

Abstract Introduction: Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging. In this paper we present a literature review of these tumors based on two case reports. Case presentation: In the first case, a 55-year-old male presented with an inoperable pancreatic head/body junction tumor. Endoscopic ultrasound-guided fine needle aspiration was practiced, and histopathological examination revealed a squamous cell carcinoma of the pancreas. After exclusion of any another tumor, the diagnosis of cT4N0M0-staged primary pancreatic SCC was made. The patient is under treatment with gemcitabine and oxaliplatin. The second case is represented by a 73-year-old patient in which imagistic examinations highlighted a cystic mass of the pancreatic body. Following coporeo-caudal splenic-pancreatectomy and histopathological-proved diagnosis of adenosquamous carcinoma, the patient started chemotherapy but died at 11 months after surgery. Both tumor components displayed positivity for markers which prove ductal (cytokeratin19, maspin) and squamous differentiation (p63, cytokeratin5/6) same as vimentin, as indicator of epithelial mesenchymal transition (EMT). Conclusions: SCC and adenosquamous carcinoma of the pancreas are aggressive malignancies which prognosis remains highly reserved. These tumors might be variants of ductal adenocarcinomas which are dedifferentiated through EMT phenomenon.

Primary squamous cell carcinoma of the pancreas with a large pseudocyst of the pancreas as the first manifestation: a rare case report and literature review

BackgroundPrimary squamous cell carcinoma (SCC) of the pancreas with pseudocysts, especially diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), is extremely rare.Case presentationA 64-year-old man was admitted to our department for abdominal distension. Two months ago, he experienced abdominal pain for 1 day and was diagnosed with acute pancreatitis in another hospital. After admission, laboratory tests showed the following: amylase 400 U/L, lipase 403 U/L, and carbohydrate antigen 19–9 (CA19-9) 347 U/mL. Abdominal computed tomography (CT) revealed pancreatitis with a pseudocyst with a diameter measuring 7 cm. During linear EUS, a large pseudocyst (5.4 × 5.2 cm) was observed in the pancreatic body. EUS-FNA was performed. We obtained specimens for histopathology and placed a plastic stent through the pancreas and stomach to drain the pseudocyst. Puncture fluid examination revealed the following: CA19-9 > 12,000 U/mL carcinoembryonic antigen (CEA) 7097.42 ng/ml, amylase 27,145.3 U/L, and lipase > 6000 U/L. Cytopathology revealed an abnormal cell mass, and cancer was suspected. Furthermore, with the result of immunohistochemistry on cell mass (CK ( +), P40 ( +), p63 ( +), CK7 (−) and Ki-67 (30%)), the patient was examined as squamous cell carcinoma (SCC). However, the patient refused surgery, radiotherapy and chemotherapy. After drainage, the cyst shrank, but the patient died 3 months after diagnosis due to liver metastasis and multiple organ failure.ConclusionFor patients with primary pancreatic pseudocysts with elevated serum CEA and CA19-9 levels, we should not rule out pancreatic cancer, which may also be a manifestation of primary pancreatic SCC. EUS-FNA is helpful for obtaining histopathology and cytology and thus improving diagnostic accuracy.

S2032 A Rare Case of Metastatic Esophageal Squamous Carcinoma With Pancreatic Metastasis

INTRODUCTION: Pancreatic tumors are typically primary neoplasms, with the majority consisting of ductal adenocarcinomas. Primary squamous cell carcinoma (SCC) of the pancreas is extremely rare, and therefore if found, metastatic disease should be considered. Metastasis to the pancreas is also uncommon with an incidence from 0.7% to 11.1%. Diagnostic evaluation can be challenging as the diagnosis itself can be unreliable based on immunohistochemical staining. We hereby present a case of an esophageal mass found incidentally during workup of a known pancreatic mass, both ultimately proven to be SCC. CASE DESCRIPTION/METHODS: A 64-year old male with past medical history of prior smoking, gastroesophageal reflux disease, esophageal stricture, and prostate cancer presented with 2 months of intermittent periumbilical abdominal pain and nausea. Work-up was noteworthy for CT of the abdomen and pelvis which showed an ill-defined 4.5 × 3.4 cm pancreatic tail mass with peripancreatic stranding, and upper abdominal lymphadenopathy. Serum tumor markers CA 19-9 and CEA were normal. EGD revealed a 2 cm friable, non-obstructing mass in the middle third of the esophagus (Figure 1). On EUS, the mass was noted to invading the muscularis propria. EUS was further notable for a 42 mm by 39 mm hypoechoic mass in the pancreatic tail (Figure 2) and peri-aortic lymphadenopathy. Biopsy and immunohistochemical staining of the esophageal mass, pancreatic mass, and per-aortic lymph nodes are illustrated in Figure 3. The clinical picture was thought to be most likely metastatic SCC of esophageal origin. Palliative chemotherapy with FOLFOX was initiated. DISCUSSION: Primary SCC of the pancreas is extremely rare, and thus requires extensive workup for metastatic disease including CT of the head and chest, upper endoscopy, colonoscopy, pelvic exam with pap smear, and a detailed skin examination. Pancreatic metastasis from another primary site is also rare. Esophageal SCC metastasis to the pancreases is particularly uncommon, with an incidence of 0% to 4.8%. As highlighted by this case, appropriate diagnosis of SCC of a pancreatic mass for treatment guidance remains challenging as metastatic SCC may mimic primary pancreatic malignancy both clinically and cytologically. Therefore, even with tissue diagnosis, primary pancreatic SCC cannot be cytologically distinguished from metastatic SCC through immunohistochemistry and often requires clinical correlation after an extensive workup.Figure 1.: EGD revealed a 2 cm friable, non-obstructing mass in the middle third of the esophagus.Figure 2.: EUS showed a 42 mm by 39 mm hypoechoic mass in the pancreatic tail.Figure 3.: Findings of the biopsies and immunohistochemical staining of the esophageal mass, pancreatic mass, and per-aortic lymph nodes.

The impact of squamous cell carcinoma histology on outcomes in nonmetastatic pancreatic cancer.

BackgroundThe prognosis for nonmetastatic, primary pancreatic squamous cell carcinoma (SCC) is thought to be poor compared with adenocarcinoma (AC); however, this is based on limited data. Additionally, the optimal definitive treatment strategy for nonmetastatic pancreatic SCC is unknown.MethodsWe analyzed patients with nonmetastatic pancreatic cancer using the National Cancer Database for patients diagnosed from 2006 to 2014. Patients were analyzed according to histology—only AC, adenosquamous carcinoma (A‐SCC), and SCC were included. The primary endpoint was overall survival (OS) from the time of diagnosis.ResultsA total of 94 928 cases were included; 94 016 AC, 757 A‐SCC, and 155 SCC. Median OS was lower for SCC (8.67 months), compared to AC (13.93 months) and A‐SCC (12.71 months, P < .001). SCC was resected less often (25.5% vs 46.7% and 74.5%). On subgroup analysis of patients with pancreatic SCC, factors on multivariate analysis associated with improved survival included surgery (HR 0.19, P < .001), and chemotherapy (HR 0.22, P = .01). In 38 patients with SCC undergoing surgical resection, median OS improved (MS = 6.8 months without surgery vs 21.3 months with surgery, P < .001).ConclusionsNonmetastatic pancreatic SCC presents with more advanced disease, which is less often surgically resected or treated with any definitive local therapy. In contrast, AC and A‐SCC behave more similarly and have higher surgical resection rates and improved survival. In patients with nonmetastatic SCC of the pancreas, surgical resection provides the most significant survival benefit, with systemic chemotherapy providing a less significant benefit, and localized radiation providing no statistical benefit for any subgroup.

Survival and prognostic factors in patients with pancreatic squamous cell carcinoma

ObjectivesSquamous cell carcinoma (SCC) of pancreas is rare entity with poorly defined prognostic factors and therapeutic outcomes. We sought to determine the overall survival (OS) and prognostic factors of patients with pancreatic SCC using National Cancer Database (NCDB) (2004–15). MethodsKaplan-Meier method and log-rank test were used to perform OS analysis. Propensity-matched analysis was used to compare the OS of pancreatic SCC and adenocarcinoma. ResultsOf the 515 cases included in our analysis, 46% were female. Approximately half of the cohort (48%) received chemotherapy or radiation therapy or both. Twenty six percent (33/125) of stage I and II disease (localized disease), 11% (8/72) of stage III, and 2% (6/318) of stage IV disease underwent surgical resection of the primary tumor. Median OS for the entire cohort was 4 months and was significantly higher in patients who underwent surgical resection of the primary tumor (17 vs 4 months, p < 0.001). In localized disease, adjuvant chemotherapy was not associated with improved OS in early stage disease (20 vs 24 months, p = 0.60). Stage IV patients treated with chemotherapy had a better OS than those without (5 vs 2 months, p < 0.0001). Propensity matched analysis demonstrated no significant differences in median OS between pancreatic adenocarcinoma (4.8 months) and SCC (4 months, p = 0.09). ConclusionsPancreatic SCC had a diverse OS that varied significantly according to increasing age (>70 years) and stage of the disease at presentation (p < 0.01). Surgical resection of primary tumor was associated with longer OS in stages I-II, whereas chemotherapy was associated with longer OS in stage IV disease.

Retraction: The Human Homolog of Drosophila Headcase Acts as a Tumor Suppressor through Its Blocking Effect on the Cell Cycle in Hepatocellular Carcinoma.

The molecular pathogenesis of hepatocellular carcinoma (HCC) is heterogeneous and extremely complex. Thus, for individual molecular targeted therapy, novel molecular markers are needed. The abnormal expression of the human homolog of Drosophila headcase (HECA homo) has been found in pancreatic, colorectal, and oral squamous cell carcinoma. Studies of oral squamous cell carcinoma have also demonstrated that the HECA homo protein can be negatively controlled by the Wnt-pathway and transcription factor 4 (TCF4) and can slow cell division by interacting with cyclins and CDKs. However, the role of HECA in HCC has not been reported elsewhere. Here, immunohistochemical analysis revealed that the downregulation of HECA homo protein occurred in 71.0% (66/93) of HCC cases and was positively correlated with a poorly differentiated grade, high serum AFP level, liver cirrhosis and large tumor size. The expression of HECA homo was detected in five live cell lines. In vitro, the overexpression of HECA homo in HepG2, Huh-7 and MHCC-97H cells could inhibit cell proliferation and colony formation and induce G1 phase arrest. In contrast, the downregulation of HECA homo could promote cell proliferation, colony formation and the cell cycle process. However, neither the overexpression nor downregulation of HECA homo in the three cell lines could affect cell migration or invasion. Collectively, HECA homo is regularly expressed in normal live cells, and the HECA homo protein level is heterogeneously altered in HCC, but the downregulation of HECA homo is more common and positively correlated with several malignant phenotypes. The HECA homo protein can slow cell proliferation to some extent primarily through its blocking effect on the cell cycle. Hence, the HECA homo protein may act as a tumor suppressor in HCC and might be a potential molecular marker for diagnostic classification and targeted therapy in HCC.

Management of primary squamous cell carcinoma of the pancreas with a nanosomal paclitaxel lipid suspension-based regimen: A case report.

Squamous cell carcinoma (SCC) of the pancreas is a rare tumor with only a few case reports available. It is an aggressive form of pancreatic cancer with a poor prognosis. The diagnosis and optimal management of SCC of the pancreas is poorly defined due to the lack of standard treatment or guidelines and owing to the rarity of this malignancy. Patients suffering from SCC of the pancreas do not respond well to chemotherapy or radiotherapy and isolated reports are available on the use of gemcitabine and newer taxane formulations. Surgical resection of the tumor is the most effective modality; however, due to a delay in diagnosis, the majority of pancreatic SCCs remain unresectable. Herein, a case of SCC of the pancreatic tail is reported in a 60-year-old patient who was managed with a combination of albumin-free nanosomal paclitaxel lipid suspension (NPLS) and gemcitabine in a neoadjuvant setting. To the best of our knowledge, this is the first such case report of a locally advanced SCC of the pancreatic tail showing an overall survival of 1 year following treatment with an NPLS based regimen. The treatment was well tolerated with no serious safety concerns.

Predictors of survival in pancreatic squamous cell carcinoma (PSCC): An analysis from the National Cancer Database (NCDB).

399 Background: PSCC is a rare form of exocrine pancreatic malignancy with a dismal prognosis. Using the NCDB, we determined the prognostic factors and survival outcomes of PSCC in the United States. Methods: We performed a retrospective analysis of patients with histologically confirmed PSCC from 2004-2015 using NCDB. Kaplan-Meier method and log-rank test were used to perform overall survival (OS) analysis. Hazard Ratios were calculated using the Cox-proportional hazard method. Results: Of the 654 cases included in our analysis, 46% were female. Median age at diagnosis was 70 years and did not differ by sex (p = 0.19). The proportion of patients with stage I, II, III and IV diseases were 5%, 18%, 12%, and 54%, respectively (10%, unknown stage). Among these, 23% (35 of 150) of stage I and II disease, 10% (8 of 78) of stage III, and 2% (7 of 353) received surgical resection of the primary tumor. The rate of R0 resection was 74% in stage I and II; 38% in stage III; 29% in stage IV disease. Median OS for the entire cohort was 4 months and was significantly higher in patients who received surgical resection of the primary tumor (17 vs. 4 months, p &lt; 0.001). On stage wise sub-group analysis, stage I-II patients had OS benefit from surgery (21 vs. 5 months, p &lt; 0.001) as opposed to stage III (7 vs. 6 months, p = 0.31) and IV disease (5 vs. 3 months, p = 0.17). Adjuvant chemotherapy had no role in prolonging survival in stage I-II disease (20 vs 24 months, p = 0.6). Stage IV patients treated with chemotherapy had a better median OS than those without (5 vs. 2 months, p &lt; 0.0001). On Cox multivariable analysis, stage IV disease (HR: 1.92 CI: 1.46-2.52, p &lt; 0.001) and advanced patient age (HR: 1.02; CI:1.01-1.03, p &lt; 0.001 were associated with poor OS, whereas OS was not dependent on the sex, race, grade, insurance status, surgery, and chemotherapy. Conclusions: This is the largest registry-based study on PSCC to date. PSCC had a diverse OS varied significantly according to increasing age and stage of the disease at presentation. Surgical resection of primary tumor was associated with improved OS in stages I-II, whereas chemotherapy improved OS in stage IV disease. The results of our study may aid the prognostication of patients and in treatment decision making.

Risk score and prognosis modeling based on mRNA expressivity in the tumor microenvironment of GI cancers.

608 Background: Stromal elements in the tumor microenvironment (TME) impact prognosis and response to therapy. Advances in mRNA-seq improved understanding of gene expressivity, but few models exist to model prognosis in association with mRNA expression. Methods: Clinical data and mRNA-seq of 1,715 patients (pts) – pancreatic adenocarcinoma (PAAD), colorectal adenocarcinoma (CRC), hepatocellular carcinoma (HCC), gastric adenocarcinoma (GAAD), esophageal adenocarcinoma (EsoAd), and esophageal squamous cell carcinoma (EsoSCC) – were obtained from TCGA. The expressivity of 191 genes enriched in cellular and structural components of the TME and clinical data were analyzed using machine learning, multivariable COX model, and Kaplan-Meier (KM) analysis to model risk score (RS) to predict prognosis. Results: Genes associated with good and poor prognosis were identified via machine learning and statistic methods. Higher RS represents worse prognosis with max RS = 1 (Table). In all 6 cancers, high P/G (the expression ratio of genes associated with poor to good prognosis) and old age are related to worse survival except EsoAd with younger pts having worse prognosis. The location of tumors in CRC and sex in HCC impact RS. When pts are grouped into 3 pt groups in each cancer, KM curves in pts with low, intermediate, and high RS are statistically different (p &lt; 0.0001) with high hazard ratio (HR &gt; 2). Conclusions: Analysis of large data was assisted by machine learning and statistics, identifying genes associated with survival and creating RS as a tool to predict prognosis. This provides valuable information about prognosis for pts encountered in the clinic when genomic profiles are given. Computational modeling to predict response to chemotherapy and immunotherapy is underway. [Table: see text]

Self-expandable metal stent through the tumor to treat an intestinal obstruction due to pancreatic squamous cell carcinoma.

Self-expandable metal stent through the tumor to treat an intestinal obstruction due to pancreatic squamous cell carcinoma.