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The Impact of Epidemiological Factors and Treatment Interventions on Survival in Patients With Signet Ring Cell Carcinoma of the Pancreas

Patel, Mausam, MD; Hans, Harliv S., MD; Pan, Kelsey, BS; Khan, Humza, BS; Donath, Elie, MD, MPH; Caldera, Humberto, MD

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1176–1184
doi: 10.1097/COC.0000000000000447
Original Articles: Gastrointestinal

Objectives: Primary pancreatic signet ring cell carcinoma (SRCC) is a rare histologic variant of pancreatic carcinoma. A population-based analysis of pancreatic SRCC was performed to determine the predictive effects of epidemiological factors and treatment interventions on overall survival (OS) and disease-specific survival (DSS).

Materials and Methods: The Surveillance, Epidemiology, and End Results registry was searched for pancreatic SRCC cases diagnosed between January 1, 1973 and December 31, 2013. Statistical analysis was performed using the Fisher exact test, χ2 analysis, Kaplan-Meier method, log-rank test, and Cox proportional hazards regression.

Results: The mean age among 497 patients was 66.6 years (SD, 11.9). Most patients were white (82.7%) and male (54.5%). The 1-, 2-, and 5-year OS rates were 17%, 9%, and 4%, respectively, while the corresponding 1-, 2-, and 5-year rates for DSS were 18%, 10%, and 5%, respectively. On univariable analysis; age, site, grade, stage, and treatment were predictive of OS and DSS (P<0.05). On multivariable analysis; radiation improved OS and DSS (adjusted hazard ratio [aHR], 0.592 and 0.589, respectively), pancreatectomy improved OS and DSS (aHR, 0.360 and 0.355, respectively), and combination therapy improved OS and DSS (aHR, 0.295 and 0.286, respectively). Age, site, and stage were also independent predictors of OS and DSS. Subgroup analysis demonstrated treatment to be an independent predictor of OS and DSS in localized/regional disease, in distant disease, and in patients diagnosed between 2000 and 2013.

Conclusions: Age, site, stage, and treatment independently predict OS and DSS in pancreatic SRCC.

Department of Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, FL

The authors declare no conflicts of interest.

Reprints: Mausam Patel, MD, JFK Medical Center, 5301 South Congress Ave, Atlantis, FL 33462. E-mail:

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