Underutilization of surgical resection in patients with pancreatic acinar cell carcinoma

Landa, Karenia; Freischlag, Kyle; Nussbaum, Daniel P.; Youngwirth, Linda M.; Blazer, Dan G.

doi:10.1016/j.hpb.2018.10.014

Cited by 8 publications

(12 citation statements)

References 16 publications

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“…A more recent study containing 340 metastatic ACC cases from National Cancer Data Base (NCDB) indicated that patients required resection correlated with an increased 5-year survival rate compared with those who did not undergo resection (18.7% vs. 3.8%, P < 0.001). 22 As liver is the most common metastatic site of ACC patients, this result might also provide evidence to support the role of surgical resection in liver metastatic cases. However, it needs to be well evaluated in large-scale studies with good designs.…”

Section: Discussionmentioning

confidence: 62%

Clinical Analysis of Acinar Cell Carcinoma of the Pancreas: A Single-Center Experience of 45 Consecutive Cases

et al. 2020

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Backgrounds: Acinar cell carcinoma of the pancreas is a rare malignancy, and its features remain unclear. We aimed to analyze the clinical characteristics, treatment and prognosis of acinar cell carcinoma with our institutional case series. Methods: Patients diagnosed with acinar cell carcinoma in our hospital between 2005 and 2019 were reviewed. Investigations on clinicopathological features, treatment details and long-term survival were performed. Results: A total of 45 pathologically confirmed acinar cell carcinomas were identified. The median age at diagnosis was 58 years with a male-to-female ratio of 3.1:1. There were 24 (53.3%) localized, 5 (11.1%) locally advanced and 16 (35.6%) metastatic cases, with a pancreatic head-to-body/tail ratio of 1:1.4 for all the primary lesions. In the localized group, there were 10 pancreatoduodenectomy, 12 distal pancreatectomy, 1 total pancreatectomy, and 1 distal pancreatectomy combined with proximal gastrectomy. Among the locally advanced and metastatic cases, 13 patients received chemotherapy, 1 received concurrent radiochemotherapy, 1 underwent synchronous resection of primary tumor and liver metastasis, 1 underwent palliative operation, 1 underwent exploratory laparotomy, and 4 required no treatment. The median overall survival of this series was 18.9 months with a 5-year survival rate of 19.6%. Moreover, the resected acinar cell carcinoma patients were associated with prolonged survival compared with the unresected cases (36.6 vs. 8.5 months, P < 0.001). Conclusions: Surgical resection could improve the long-term survival of acinar cell carcinoma patients, which might also improve the prognosis of selected metastatic cases. Large-scale studies are needed to further clarify the biological behavior and clinical features, and to seek the optimal treatments.

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Section: Discussionmentioning

confidence: 62%

Clinical Analysis of Acinar Cell Carcinoma of the Pancreas: A Single-Center Experience of 45 Consecutive Cases

et al. 2020

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“…In this study, the 5-year survival rate for patients undergoing surgery was 11.7%, compared to 4.7% for patients without surgery (p<0.001). Similarly, the 5-year survival rate was significantly improved in patients who present with localregional disease receiving surgery [17,29]. Several studies also found a significant increase in OS among patients with IV stage receiving surgical resection [29,30].…”

Section: More Radical Management Methods May Achieve Longer Survivalmentioning

confidence: 92%

“…Similarly, the 5-year survival rate was significantly improved in patients who present with localregional disease receiving surgery [17,29]. Several studies also found a significant increase in OS among patients with IV stage receiving surgical resection [29,30]. This suggests that when evaluating whether ACC could be removed, the criteria should be relaxed to allow for more aggressive surgery to achieve tumor resection.…”

Section: More Radical Management Methods May Achieve Longer Survivalmentioning

confidence: 99%

The contemporary trend in worsening prognosis of pancreatic acinar cell carcinoma: A population-based study

et al. 2020

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Background Primary acinar cell carcinoma (ACC) is a rare exocrine tumor of the pancreas with unclear clinical characteristics. Our goal was to determine the incidence and update the clinical characteristics and outcomes of ACC. Methods Through the Surveillance, Epidemiology, and End Results (SEER) database, we identified 252 patients with the latest diagnosis of ACC (2004–2016). The age-adjusted incidence (AAI) was calculated using the SEER*Stat Software version 8.3.6. The Kaplan–Meier method was used to draw survival curves and differences among them were compared by the log-rank test. Cox proportional hazards models were used to evaluate factors that had independent predictive effects on the overall survival. Results The AAI of pancreatic ACC was on the rise with the mean age at diagnosis of 63.79±14.79 years. Most patients (15.9%) had poorer differentiated tumors. The patients presented with distant stage were 54.4% compared with 53.1% between 1988 and 2003. The 1-, 2-, and 5-years survival rates for pancreatic ACC patients were 53.5%, 34.6%,17.5%, respectively (compared with 78.5%, 67.0%, and 42.8%, between 1988 and 2003). The multivariate COX analysis showed that the patient's age, surgery, chemotherapy, and summary stage, but not marital status were independent prognosis factors for ACC. Conclusions Pancreatic ACC is a highly malignant tumor with an increasing incidence in recent years. The rate of distant metastasis is increasing and the survival rate is worse than in the past, suggesting that it may require more aggressive treatment and follow-up. Surgery, radiotherapy, and chemotherapy are all effective treatments, but prospective studies are still needed to verify them.

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“…In the 10 cases we know of, surgical resection was performed in 6 ( Table 1 ) and 6 of the 10 patients died within about half year after diagnosis with the outcome not stated in 2. Since most pancreatic tumors are large at the time of identification, most resectable tumors are often not resected [ 4 , 12 ]. In the case of unresectable tumors, chemotherapy can be used as first line treatment, if the tumor shrinks after chemotherapy, in absence of contraindications, adjuvant surgical resection may be performed.…”

Section: Discussionmentioning

confidence: 99%

Extended pancreato-duodenectomy coupled with adjuvant chemotherapy for SMARCB1/INI1 deficient pancreatic carcinoma: A case report and literature review

Mugaanyi

et al. 2021

International Journal of Surgery Case Reports

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Introduction SMARCB1/INI1 gene deletion appears to be associated with a rare, malignant and aggressive form of pancreatic carcinoma whose diagnosis is challenging. Our objective is to illustrate that the tumor may masquerade as a duodenal papillary carcinoma, be difficulty to identify on diagnostic imaging and that making an accurate diagnosis may be challenging, however surgical resection may be possible. Case report We present a case of a 24-year old male patient presenting with jaundice and itchy skin, elevated TBIL, AST, ALP and CA125. A 2.2 × 1.7 cm pancreatic nodule, later diagnosed as a SMARCB1/INI deficient pancreatic carcinoma was detected on Endoscopic Ultrasound - Fine Needle Aspiration (EUS-FNA). The patient was successfully treated with extended pancreato-duodenectomy coupled with adjuvant chemotherapy, a 7 × 5 × 5 cm tumor resected. Discussion SMARCB1/INI deficient pancreatic carcinoma has been reported in couple of other articles. However, unlike other cases, in our case identification and accurate assessment of the tumor was particularly difficulty both on imaging and during operation. Our patient has thus far had a positive outcome with no recurrence. Conclusion For rare forms of pancreatic carcinoma, identification and assessment of the tumor size may be challenging on imaging and during operation. However, careful assessment should be performed before ruling out surgical resection. Furthermore, adjuvant chemotherapy may be beneficial to the patient.

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Underutilization of surgical resection in patients with pancreatic acinar cell carcinoma

Cited by 8 publications

References 16 publications

Clinical Analysis of Acinar Cell Carcinoma of the Pancreas: A Single-Center Experience of 45 Consecutive Cases

Clinical Analysis of Acinar Cell Carcinoma of the Pancreas: A Single-Center Experience of 45 Consecutive Cases

The contemporary trend in worsening prognosis of pancreatic acinar cell carcinoma: A population-based study

Extended pancreato-duodenectomy coupled with adjuvant chemotherapy for SMARCB1/INI1 deficient pancreatic carcinoma: A case report and literature review

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