Acinar cell carcinoma incidence and survival based surveillance, epidemiology, and end results data, 1973 to 2012 Open Access

Sheng, Yun (2016)

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BACKGROUND: Acinar cell carcinoma (ACC) of the pancreas is a rare malignancy with little information available on the trends in incidence and survival. To date no randomized trials has been conducted to guide ACC therapy.

METHODS: Patients with ACC reported to the Surveillance, Epidemiology, and End Results (SEER) Program from 1973 through 2012 were categorized by sex, race, age, marital status, year of diagnosis, primary site, disease stage, and treatment. Then the incidence and survival were compared across different demographic and disease-related categories by calculating rate ratios (RRs) and hazard ratios (HRs) along with the corresponding 95% confidence intervals (CIs).

RESULTS: In total, 396 patients with ACC were identified. While incidence of ACC showed a gradual increase, survival remained largely unchanged. The proportion of male ACC cases increased over time from 50.7% during 1973 to 1992, up to 67.7% during 1993 to 2002, and to 72.9% during 2003 to 2012. The proportion of ACC cases originating in the head of pancreas increased over time from 27.5% during 1973 to 1992, up to 49.0% during 1993 to 2002, and down to 44.9% during 2003 to 2012. After adjusting for sex, marital status, race, disease stage, tumor site, and treatment, mortality among patients older than 70 was higher (HR= 1.72; 95% CI, 1.05-2.82) than in patients younger than 50, and mortality among patients with distant stage ACC was also elevated (HR=3.26; 95% CI, 2.00, 5.31) compared to patients with localized disease. Patients who underwent surgery (HR= 0.47; 95% CI, 0.30-0.72) or surgery and radiation (HR=0.41; 95% CI, 0.22, 0.77) had better survival than those who did not receive tumor directed treatment.

CONCLUSIONS: In recent years there has been an increase in the proportion of male ACC patients and in the percentage of ACC cases originating in the head of pancreas. Age-adjusted disease incidence appears to be higher in men than in women and in whites and American Africans compared to persons of other racial groups. Worse survival following ACC diagnosis is associated with older age and advanced disease stage. The current findings demonstrate that surgical tumor directed treatment may be associated with improved survival, although this observational can be attributed at least in part to the "immortal time bias".

Table of Contents

1. Distribution Agreement

2. Approval Sheet

3. Abstract Cover Page

4. Abstract

5. Cover Page

6. Introduction

7. Methods

8. Results

9. Discussion

10. References

11. Tables

12. Figures

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