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

Abstract

Background The 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. Methods We 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. Results A 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). Conclusions Nonmetastatic 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.

Management of Primary Squamous Cell Carcinoma of the Pancreas: A Case Report

“…There is no standard management strategy for this disease owing to the limited current clinical data on SCCP treatment ( 3 ). Therefore, the appropriate management strategy for this disease should be standardized.…”

“…Patients with locally advanced tumors who received neoadjuvant chemo-radiotherapy had better OS than those who did not ( 4 ). However, some studies suggest that neoadjuvant therapy may be unnecessary if the primary SCCP is resectable ( 3 ). Tella et al demonstrated that postoperative radiotherapy and/or chemotherapy did not improve the median OS in patients with stage I-II disease.…”

“…It has a worse survival rate and a lower cure rate than other pancreatic cancers (2), which makes the treatment of this disease challenging. While there are several treatment strategies for this disease, such as surgery, chemotherapy, and/or radiotherapy, the clinical precise management plan for primary SCCP has not been documented systematically in literature (3)(4)(5)(6). Some cases found that primary SCCP respond well to surgery, while others revealed that the disease respond to neoadjuvant chemoradiotherapy (4,6).…”

One size does not fit all for pancreatic cancers: A review on rare histologies and therapeutic approaches

“…As per the other types of PC, surgical resection is the only curative approach for ASPC and SCC , that can significantly improve survival[ 107 , 110 , 119 , 120 ]. Patients affected by ASPC or SCC undergoing surgery and post-operative treatment with chemotherapy, radiotherapy or both appear to have a benefit[ 108 , 121 - 123 ], even though there is no consensus regarding the best regimen to use, that are commonly fluoropyrimidine-based, gemcitabine based or platinum-based. Data from Johns Hopkins Hospital show, in particular, benefit for ASPC patients treated with platinum-based chemotherapy, with a mOS of 19.1 mo[ 121 ].…”

Prognostic Analysis and Influencing Serum Biomarkers of Patients With Resectable Pancreatic Adenosquamous Cancer

“…The incidence of PASC only accounts for about 1–4% of pancreatic cancer ( 2 ). The pathological manifestation is that a number of squamous cells are mixed with the adenocarcinoma cell population ( 3 ). The diagnostic criteria is that squamous cells account for at least 30% of all tumor cells in the carcinoma ( 1 ).…”