Abstract
Background
Adenosquamous carcinoma of the pancreas has historically poor survival. We analyzed
survival outcomes stratified by treatment regimen and sequence using an administrative
dataset.
Methods
Adult patients with nonmetastatic adenosquamous carcinoma of the pancreas were identified
using the National Cancer Database (2010−2016). Multivariable analyses were used to
determine factors associated with receipt of neoadjuvant or adjuvant chemotherapy.
Overall survival was estimated by Kaplan-Meier analysis and a multivariable Cox model
was used to evaluate factors associated with survival.
Results
A total of 838 patients with adenosquamous carcinoma of the pancreas were included
in the analysis. The median age was 69 years and 64.7% of patients underwent pancreatectomy.
Among patients who underwent pancreatectomy, 60.5% received adjuvant chemotherapy,
14.8% received neoadjuvant chemotherapy, and 24.7% underwent surgery alone. Older
age and increasing comorbidity index were associated with a reduced likelihood of
receiving neoadjuvant or adjuvant chemotherapy. Median survival of patients who received
chemotherapy alone was similar compared with patients who underwent pancreatectomy
alone (9.2 vs 7.2 months, P = .504). Survival was improved if patients received both chemotherapy and pancreatectomy
(neoadjuvant = 19.6 months, hazard ratio = 0.58; adjuvant = 19.4 months, hazard ratio =
0.64) compared with pancreatectomy alone.
Conclusion
Patients with adenosquamous carcinoma of the pancreas who do not receive multimodal
therapy have poor survival. The sequence of chemotherapy and pancreatectomy is not
associated with survival, but 25% of patients who undergo surgery do not receive chemotherapy.
Given that there is no difference in median survival between patients who undergo
pancreatectomy alone or receive chemotherapy alone, our data question whether neoadjuvant
chemotherapy should be considered in patients with potentially resectable adenosquamous
carcinoma of the pancreas.
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Article info
Publication history
Published online: December 26, 2020
Accepted:
November 18,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
