Braun Rüdiger, Klinkhammer-Schalke Monika, Zeissig Sylke Ruth, Kleihus van Tol Kees, Bolm Louisa, Honselmann Kim C, Petrova Ekaterina, Lapshyn Hryhoriy, Deichmann Steffen, Abdalla Thaer S A, Heckelmann Benjamin, Bronsert Peter, Zemskov Sergii, Hummel Richard, Keck Tobias, Wellner Ulrich F
Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany.
Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany.
Cancers (Basel). 2022 Aug 16;14(16):3946. doi: 10.3390/cancers14163946.
Background: Adenosquamous carcinoma of the pancreas (ASCP) is a rare malignancy and its pathophysiology is poorly understood. Sparse clinical data suggest that clinical outcome and overall survival is worse in comparison to common pancreatic ductal adenocarcinoma (PDAC). Methods: We evaluated clinical outcome and prognostic factors for overall survival of patients with ASCP in comparison to patients with PDAC recorded between 2000 and 2019 in 17 population-based clinical cancer registries at certified cancer centers within the Association of German Tumor Centers (ADT). Results: We identified 278 (0.5%) patients with ASCP in the entire cohort of 52,518 patients with pancreatic cancer. Significantly, more patients underwent surgical resection in the cohort of ASCP patients in comparison to patients with PDAC (p < 0.001). In the cohort of 142 surgically resected patients with ASCP, the majority of patients was treated by pancreatoduodenectomy (44.4%). However, compared to the cohort of PDAC patients, significantly more patients underwent distal pancreatectomy (p < 0.001), suggesting that a significantly higher proportion of ASCP tumors was located in the pancreatic body/tail. ASCPs were significantly more often poorly differentiated (G3) (p < 0.001) and blood vessel invasion (V1) was detected more frequently (p = 0.01) in comparison with PDAC. Median overall survival was 6.13 months (95% CI 5.20−7.06) for ASCP and 8.10 months (95% CI 7.93−8.22) for PDAC patients, respectively (p = 0.094). However, when comparing only those patients who underwent surgical resection, overall survival of ASCP patients was significantly shorter (11.80; 95% CI 8.20−15.40 months) compared to PDAC patients (16.17; 95% CI 15.78−16.55 months) (p = 0.007). ASCP was a highly significant prognostic factor for overall survival in univariable regression analysis (p = 0.007) as well as in multivariable Cox regression analysis (HR 1.303; 95% CI 1.013−1.677; p = 0.039). Conclusions: In conclusion, ASCP showed poorer differentiation and higher frequency of blood vessel invasion indicative of a more aggressive tumor biology. ASCP was a significant prognostic factor for overall survival in a multivariable analysis. Overall survival of resected ASCP patients was significantly shorter compared to resected PDAC patients. However, surgical resection still improved survival significantly.
胰腺腺鳞癌（ASCP）是一种罕见的恶性肿瘤，其病理生理学尚不清楚。稀少的临床数据表明，与常见的胰腺导管腺癌（PDAC）相比，其临床结局和总生存期更差。方法：我们评估了ASCP患者与2000年至2019年间在德国肿瘤中心协会（ADT）认证癌症中心的17个基于人群的临床癌症登记处记录的PDAC患者的总生存期的临床结局和预后因素。结果：在52518例胰腺癌患者的整个队列中，我们识别出278例（0.5%）ASCP患者。值得注意的是，与PDAC患者相比，ASCP患者队列中接受手术切除的患者更多（p<0.001）。在142例接受手术切除的ASCP患者队列中，大多数患者接受了胰十二指肠切除术（44.4%）。然而，与PDAC患者队列相比，接受远端胰腺切除术的患者明显更多（p<0.001），这表明ASCP肿瘤位于胰体/胰尾的比例明显更高。与PDAC相比，ASCP的低分化（G3）更为常见（p<0.001），血管侵犯（V1）的检测频率更高（p=0.01）。ASCP患者的中位总生存期为6.13个月（95%CI 5.20−7.06），PDAC患者为8.10个月（95%CI 7.93−8.22）（p=0.094）。然而，仅比较那些接受手术切除的患者时，ASCP患者的总生存期明显短于PDAC患者（11.80；95%CI 8.20−15.40个月）（16.17；95%CI 15.78−16.55个月）（p=0.007）。在单变量回归分析（p=0.007）以及多变量Cox回归分析（HR 1.303；95%CI 1.013−1.677；p=0.039）中，ASCP是总生存期的一个高度显著的预后因素。结论：总之，ASCP显示出较差的分化和较高的血管侵犯频率，表明其肿瘤生物学行为更具侵袭性。在多变量分析中，ASCP是总生存期的一个显著预后因素。与接受手术切除的PDAC患者相比，接受手术切除的ASCP患者的总生存期明显更短。然而，手术切除仍显著改善了生存期。
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