Histological variants of pancreatic ductal adenocarcinoma: a survival analysis.

IF 2.1 3区医学 Q2 SURGERY Langenbeck's Archives of Surgery Pub Date : 2024-10-19 DOI:10.1007/s00423-024-03506-6

Axel Bengtsson, Roland Andersson, Daniel Ansari

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Abstract

Purpose: Pancreatic ductal adenocarcinoma (PDAC) can be classified into distinct histological subtypes based on the WHO nomenclature. The aim of this study was to compare the prognosis of conventional PDAC (cPDAC) against the other histological variants at the population level.

Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients with microscopically confirmed PDAC. These patients were divided into 9 histological subgroups. Overall survival was assessed using the Kaplan-Meier method and Cox regression models stratified by tumor histology.

Results: A total of 159,548 patients with PDAC were identified, of whom 95.9% had cPDAC, followed by colloid carcinoma (CC) (2.6%), adenosquamous carcinoma (ASqC) (0.8%), signet ring cell carcinoma (SRCC) (0.5%), undifferentiated carcinoma (UC) (0.1%), undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) (0.1%), hepatoid carcinoma (HC) (0.01%), medullary carcinoma of the pancreas (MCP) (0.006%) and pancreatic undifferentiated carcinoma with rhabdoid phenotype (PUCR) (0.003%). Kaplan-Meier curves showed that PUCR had the worst prognosis (median survival: 2 months; 5-year survival: 0%), while MCP had the best prognosis (median survival: 41 months; 5-year survival: 33.3%). In a multivariable Cox model, several histological subtypes (i.e. CC, ASqC, SRCC, UCOGC) were identified as independent predictors of overall survival when compared to cPDAC.

Conclusion: PDAC is a heterogenous disease and accurate identification of variant histology is important for risk stratification, as these variants may have different biological behavior.

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胰腺导管腺癌的组织学变异：存活率分析。

目的：根据世界卫生组织的命名，胰腺导管腺癌（PDAC）可分为不同的组织学亚型。本研究的目的是在人群水平上比较传统 PDAC（cPDAC）与其他组织学变种的预后：方法：利用监测、流行病学和最终结果（SEER）数据库确定经显微镜确诊的 PDAC 患者。这些患者被分为 9 个组织学亚组。采用Kaplan-Meier法和Cox回归模型评估了按肿瘤组织学分层的总生存率：结果：共发现 159548 例 PDAC 患者，其中 95.9% 患有 cPDAC，其次是胶样癌（CC）（2.6%）、腺鳞癌（ASqC）（0.8%）、印戒细胞癌（SRCC）（0.5%）、未分化癌（UC）（0.1%）、具有破骨细胞样巨细胞的未分化癌（UCOGC）（0.1%）、肝样癌（HC）（0.01%）、胰腺髓样癌（MCP）（0.006%）和具有横纹肌样表型的胰腺未分化癌（PUCR）（0.003%）。Kaplan-Meier 曲线显示，PUCR 的预后最差（中位生存期：2 个月；5 年生存率：0%），而 MCP 的预后最好（中位生存期：41 个月；5 年生存率：33.3%）。在多变量 Cox 模型中，与 cPDAC 相比，几种组织学亚型（即 CC、ASqC、SRCC、UCOGC）被确定为总生存期的独立预测因子：PDAC是一种异质性疾病，准确识别变异组织学对于风险分层非常重要，因为这些变异可能具有不同的生物学行为。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.