Clinical Outcomes for Anaplastic Pancreatic Cancer: A Population-Based Study

Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN.
Journal of the American College of Surgeons (Impact Factor: 5.12). 11/2012; 215(5):627-34. DOI: 10.1016/j.jamcollsurg.2012.06.418
Source: PubMed


Anaplastic pancreatic cancer (APC) is a rare subtype of pancreatic ductal adenocarcinoma (PDA) that can carry a worse overall survival (OS) when compared with other variants. However, the presence of osteoclast-like giant cells (OCGCs) in APC specimens can predict improved OS. The aim of this study was to evaluate the OS of patients with APC (with and without OCGCs) compared with patients with other subtypes of PDA using a population-based registry.
We identified all patients in the Surveillance, Epidemiology and End Results (SEER) database with pathologically confirmed APC and PDA diagnosed between 1988 and 2008. Overall survival was evaluated using Kaplan-Meier and Cox proportional hazard regression.
The study cohort included 5,859 (94.3%) patients with PDA and 353 (5.7%) with APC. Overall survival for all patients with APC was significantly worse than for patients with PDA (hazard ratio [HR] = 1.9; 95% CI, 1.7-2.1; p < 0.001); however, in the subgroup of resected patients, APC (n = 81) had similar OS to PDA (n = 3,517) (HR = 0.9; 95% CI, 0.7-1.2; p = 0.37). Patients with APC tumors with OCGCs (n = 11) demonstrated improved OS when compared with all other APC variants without OCGCs (n = 342) (HR = 0.3; 95% CI, 0.1-0.7; p = 0.004), but this survival difference was not observed in the subgroup of resected patients (HR = 0.5; 95% CI, 0.2-1.4; p = 0.18).
Anaplastic pancreatic cancer is a rare malignancy with poor OS. The diagnosis of APC with OCGCs is predictive of improved OS compared with other patients with APC. This survival benefit, however, is not observed in patients with resected disease.

Download full-text


Available from: Rondell P D Graham, Oct 07, 2015
71 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic cancer is one of the most lethal human malignancies with a very low 5-year survival rate, which highlights urgent needs for more effective therapeutic strategies. In this study, we examined the potential therapeutic effects of an adenovirus encoding human interferon gamma (Ad-IFNγ) on pancreatic carcinoma cells Capan-2 in vitro and in vivo. The results indicated that Ad-IFNγ could significantly inhibit tumor cell growth via inducing cell apoptosis. After infection, IFNγ expressed durably and stably in xenografts, predominantly in tumor tissue, while much less in blood and liver. Thus, adenovirus-mediated intratumoral injection of human IFNγ gene could be an effective gene therapeutic system for the treatment of pancreatic carcinoma. Anat Rec, 00:000-000, 2013. © 2013 Wiley Periodicals, Inc.
    The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 04/2013; 296(4). DOI:10.1002/ar.22661 · 1.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We herein report a case of anaplastic carcinoma of the pancreas with remarkable intraductal tumor growth into the main pancreatic duct. A 76-year-old male was referred to our hospital for treatment of a pancreatic tumor. Preoperative examinations revealed a poorly defined tumor in the main pancreatic duct in the body of the pancreas, accompanied with severe dilatation of the main pancreatic duct, which was diagnosed as an intraductal papillary-mucinous neoplasm. We performed distal pancreatectomy and splenectomy. The pathological examination revealed that the tumor consisted of a mixture of anaplastic carcinoma (giant cell type) and adenocarcinoma in the pancreas. There was a papillary projecting tumor composed of anaplastic carcinoma in the dilated main pancreatic duct. The patient is now receiving chemotherapy because liver metastasis was detected 12 mo after surgery. In this case, we could observe a remarkable intraductal tumor growth into the main pancreatic duct. We also discuss the pathogenesis and characteristics of this rare tumor with specific tumor growth.
    World Journal of Gastroenterology 01/2014; 20(3):852-6. DOI:10.3748/wjg.v20.i3.852 · 2.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Les cancers anaplasiques du pancréas sont des tumeurs rares très agressives. Nous rapportons une nouvelle observation d’une patiente atteinte d’un carcinome anaplasique sarcomatoïde du pancréas. A travers notre observation et une revue de la littérature, nous précisons les particularités de cette entité rare. Observation Une femme de 50 ans était hospitalisée pour une douleur épigastrique sans altération de ľétat général. Ľexamen abdominal était normal. Ľéchographie abdominale avait montré une masse hypoéchogène et hétérogène au niveau de ľépigastre faisant 7×5,5×6,7 cm avec de multiples adénopathies de ľétage sus-mésocolique. Le scanner abdominal avait conclu à une volumineuse tumeur de la queue du pancréas avec un envahissement locorégional important associée à trois nodules hépatiques métastatiques. Il n’y avait pas d’autres localisations métastatiques à distance. Les marqueurs tumoraux (ACE et CA 19-9) étaient négatifs. La biopsie pancréatique sous contrôle scannographique avait conclu à un carcinome anaplasique sarcomatoïde, largement nécrosé du pancréas. Microscopiquement, la tumeur était formée par une prolifération anaplasique, épithéliale et sarcomatoïde. Ľexamen immunohistochimique avait objectivé pour les cellules tumorales épithéliales une positivité des anticorps anti CA19.9, EMA, Kératine AE1/AE3et une négativité du CD34, CD117, Chromogranine, Desmine, Synaptophysine tandis que les cellules de la composante anaplasique et sarcomatoide étaient négatives pour tous ces marqueurs. La patiente a été traitée par une chimiothérapie palliative par gemcitabine. Elle était décédée 4 mois après le début de la chimiothérapie. Conclusion A travers cette observation et une revue de la littérature, nous précisons les caractéristiques épidémiocliniques et évolutives de cette tumeur rare ainsi que les hypothèses physiopathologiques de la carcinogenèse des tumeurs anaplasiques du pancréas.
    Journal Africain d?Hépato-Gastroentérologie 12/2014; 8(4):246-249. DOI:10.1007/s12157-014-0564-6