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PRIMARY SQUAMOUS CELL CARCINOMA OF THE PANCREAS: A COMPARATIVE SURVIVAL ANALYSIS OF A RARE DISEASE WITH A CASE PRESENTATION AND LITERATURE REVIEW
Presentation Number: Mo1236
View PresentationAuthorBlock: Alessandra Nagar3, Petr Protiva2,1
1Yale University School of Medicine, New Haven, Connecticut, United States; 2VA Connecticut Healthcare System - West Haven Campus, West Haven, Connecticut, United States; 3Northeastern University, Boston, Massachusetts, United States;
Background: Primary Squamous cell carcinoma (SCC) of the pancreas is a very rare malignancy with unknown prognosis and unclear management.
Aim: We present a patient with primary SCC of the pancreas, review the literature and perform a survival analysis using Surveillance, Epidemiology and End Result database (SEER), comparing SCC to adenocarcinoma of the pancreas.
Methods: We compared the survival experience using Mantel-Haenszel Log-Rank Test. Relative hazard ratios (HRs) for cancer related death in the 3-year period following diagnosis were estimated with Cox proportional hazard model. The independent effect of cancer histology was assessed and adjusted for relevant covariates listed in Table 1. Data was analyzed using SAS 9.4 software and R. The P value level of significance was set at <0.05 for a two-sided test.
Case presentation: A 70-year-old male presented with abdominal pain, weight loss and jaundice. Laboratory investigation showed severe cholestasis. CT scan demonstrated a 7 cm mass in the pancreas head with vascular invasion (Figure 1A). EUS (Figure 1B) FNA revealed a poorly differentiated squamous cell carcinoma, Stage III. Work up was negative for tumors in lung or esophagus. The patient was treated with FOLFIRINOX, Gemcitabine and Abraxane and died in 7 months from his cancer.
Literature review: Imaging and histological examination differentiates SCC from adenocarcinoma of the pancreas. CT findings include enhancement of the tumor and a blush pattern on angiography. Endoscopic ultrasound with biopsy is essential to demonstrate keratinization, epithelial cells in nests and stains for cytokeratin and P40. Pancreas SCC is rare, work up is essential to exclude metastasis from SCC of lung, head and neck or esophagus. Due to its rarity, there is no recommended standard chemotherapy. Regimens include Gemcitabine, Cisplatin, 5-FU, Oxaliplatin and carboplatin and Paclitaxel.
Results: We identified 110,525 cases of pancreas cancer, including 408 cases of SCC and 110,117 cases of adenocarcinoma with complete set of survival data in the SEER database. The Figure 1C shows that SCC of pancreas is associated with a significantly worse survival experience compared with adenocarcinoma of the pancreas (P<0.0072). Table 1 shows the results of the multivariate Cox regression analysis for independent effect of the two types of pancreatic cancers. The adjusted model is shown in the table with corresponding hazard ratios and P values.
Conclusion: The analysis of one of the largest data set pancreatic SCC cases showed this rare cancer is associated with worse survival experience compared to adenocarcinoma. There is currently uncertainty about the treatment options including choice of chemotherapy. More clinical and molecular data are needed to improve the prognosis in this malignancy.