The importance of multimodal therapy in the management of nonmetastatic adenosquamous carcinoma of the pancreas: Analysis of treatment sequence and strategy

Hue, Jonathan J.; Katayama, Erryk S.; Sugumar, Kavin; Winter, Jordan M.; Ammori, John B.; Rothermel, Luke D.; Hardacre, Jeffrey M.; Ocuin, Lee M.

doi:10.1016/j.surg.2020.11.026

Cited by 15 publications

(18 citation statements)

References 33 publications

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“…The similar clinical presentations to PDAC such as abdominal pain, weight loss, and jaundice make it difficult to distinguish PASC from conventional PDAC. Previous trials have confirmed the survival benefit of surgery and adjuvant chemotherapy in patients with PASC ( 12 , 40 , 41 ). In a large-scale study with matched-pair analysis to evaluate the OS between PASC and PDAC, although the former was frequently inclined to characterize with more aggressive behaviors, the 5-year survival probabilities were comparable after surgical resection ( 15 ).…”

Section: Discussionmentioning

confidence: 79%

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Development and Validation of Nomograms to Predict Overall Survival and Cancer-Specific Survival in Patients With Pancreatic Adenosquamous Carcinoma

2022

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BackgroundPancreatic adenosquamous carcinoma (PASC) is a heterogeneous group of primary pancreatic cancers characterized by the coexistence of both glandular and squamous differentiation. The aim of this study was to develop nomograms to predict survival outcomes in patients with PASC.MethodsIn this retrospective study, data on PASC, including clinicopathological characteristics, treatments, and survival outcomes, were collected from the SEER database between 2000 and 2018. The primary endpoints were overall survival (OS) and cancer-specific survival (CSS). The eligible patients were randomly divided into development cohort and validation cohort in a 7:3 ratio. The nomograms for prediction of OS and CSS were constructed by the development cohort using a LASSO-Cox regression model, respectively. Besides the model performance was internally and externally validated by examining the discrimination, calibration, and clinical utility.ResultsA total of 632 consecutive patients who had been diagnosed with PASC were identified and randomly divided into development (n = 444) and validation (n = 188) cohorts. In the development cohort, the estimated median OS was 7.0 months (95% CI: 6.19–7.82) and the median CSS was 7.0 months (95% CI: 6.15–7.85). In the validation cohort, the estimated median OS was 6.0 months (95% CI: 4.46–7.54) and the median CSS was 7.0 months (95% CI: 6.25–7.75). LASSO-penalized COX regression analysis identified 8 independent predictors in the OS prediction model and 9 independent risk factors in the CSS prediction model: age at diagnosis, gender, year of diagnosis, tumor location, grade, stage, size, lymph node metastasis, combined metastasis, surgery, radiation, and chemotherapy. The Harrell C index and time-dependent AUCs manifested satisfactory discriminative capabilities of the models. Calibration plots showed that both models were well calibrated. Furthermore, decision curves indicated good utility of the nomograms for decision-making.ConclusionNomogram-based models to evaluate personalized OS and CSS in patients with PASC were developed and well validated. These easy-to-use tools will be useful methods to calculate individualized estimate of survival, assist in risk stratification, and aid clinical decision-making.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 85%

Development and Validation of Nomograms to Predict Overall Survival and Cancer-Specific Survival in Patients With Pancreatic Adenosquamous Carcinoma

2022

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“…PASC is a rare histological type of pancreatic cancer, accounting for 1 %–4 % of all pancreatic cancers [2] , [10] , [11] . Usually, PASC shows aggressive behavior, and the prognosis even after curative surgery remains poorer than that of conventional PDAC [2] , [10] , [11] , [12] . Boecker et al reported that the median OS of patients with PASC tends to be worse than that of PDAC (8.2 months vs. 20.1 months, P = 0.089) [10] .…”

Section: Discussionmentioning

confidence: 99%

Delayed local recurrence of pancreatic adenosquamous cell carcinoma after curative surgery: A case report

Watanabe

Abe²,

Oshita³

et al. 2022

International Journal of Surgery Case Reports

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“…Pancreatic adenosquamous carcinoma (ASPC) is a rare subtype of malignant pancreatic tumor that accounts for 0.6%–4% of pancreatic exocrine tumors, with a reported incidence of 0.38%–10%. The mortality rate of pancreatic adenosquamous carcinoma is significantly higher than that of pancreatic ductal adenocarcinoma, and the prognosis of patients is extremely poor, with a median survival of only 4.4–13.1 months, and only a few patients survived for more than 1 year ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Single-cell sequencing reveals heterogeneity between pancreatic adenosquamous carcinoma and pancreatic ductal adenocarcinoma with prognostic value

Zhang¹,

Wu²,

Pan³

et al. 2022

Front. Immunol.

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Pancreatic adenosquamous carcinoma (ASPC) is a rare subtype of pancreatic cancer with lethal malignancy, and few studies have focused on the heterogeneity of ASPC. Here, we performed a single-cell sequencing procedure on pancreatic tumor tissue from an ASPC patient and a patient with high-grade intraductal papillary mucinous neoplasm (IPMN). Through the combined analysis of single-cell sequencing data from five pancreatic ductal adenocarcinoma (PDAC) patients, one IPMN patient, and one ASPC patient in a public database, we identified 11 main types of cells, including macrophages, B cells, cancer stem cells, ductal cells, fibroblasts, endo/stellate cells, neutrophils, acinar cells, T cells, natural killer (NK) cells, dendritic cells, and mast cells. Then, the different characteristics and differentiation paths of the immune microenvironment among IPMN, ASPC, and PDAC in macrophages, T cells, and cancer-associated fibroblasts (CAFs) were identified through multiple bioinformatics analyses. Two novel special cancer-associated fibroblasts were identified as nCAFs and imCAFs. Then, cancer cells in duct cells were identified using the infercnv software. Two ASPC-specific subgroups of cancer cells with squamous cell features were identified. Finally, the identified specific CAFs and cancer cells were mapped to TCGA-PAAD cohort through the cibersoftx software. All of these identified subgroups were calculated to have a significant prognostic value in pancreatic cancer patients. These findings will promote the clinical application of single-cell sequencing data of pancreatic cancer and deepen our understanding of ASPC.

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The importance of multimodal therapy in the management of nonmetastatic adenosquamous carcinoma of the pancreas: Analysis of treatment sequence and strategy

Cited by 15 publications

References 33 publications

Development and Validation of Nomograms to Predict Overall Survival and Cancer-Specific Survival in Patients With Pancreatic Adenosquamous Carcinoma

Development and Validation of Nomograms to Predict Overall Survival and Cancer-Specific Survival in Patients With Pancreatic Adenosquamous Carcinoma

Delayed local recurrence of pancreatic adenosquamous cell carcinoma after curative surgery: A case report

Single-cell sequencing reveals heterogeneity between pancreatic adenosquamous carcinoma and pancreatic ductal adenocarcinoma with prognostic value

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