E187: The Role of Chemotherapy in the Management of Pancreatic Acinar Cell Carcinoma

Introduction: Pancreatic acinar cell carcinoma (pACC) is a rare malignancy with unique clinical and molecular features. The role of chemotherapy in pACC management is not well established.

Methods: Patients with pACC were identified in the National Cancer Database (NCDB) from 2004-2020. Cox regression analysis was performed in resected pACC patients to identify significant predictors of overall survival (OS). Patients were then divided based on these risk factors into propensity-matched groups of surgery vs. surgery + chemotherapy, and Kaplan Meier analysis was performed with log-rank tests to compare OS.

Results: The analysis included 1,553 patients. Mean age was 65.2 ± 12.5 years and 1,090 (70.2%) were males. 622 (40.0%) patients received chemotherapy only, 257 (16.5%) had surgery only, and 365 (23.5%) had both. 189 patients who received surgery only were matched to peers who had surgery + chemotherapy. The median OS was similar for surgery only versus surgery + chemotherapy (57.8 ± 6.0 vs. 54.2 ± 9.9 months, p=0.836). Cox regression analysis identified positive nodal (2.04, p < 0.001) and positive margin status (1.42, p=0.013) as independent predictors of decreased OS. Propensity-matching was performed 1:1 for the receipt of surgery only vs. surgery + chemotherapy within the following subgroups of patients: node-negative, node-positive, margin-negative, and margin-positive resections. There was no OS benefit with the addition of chemotherapy in margin-positive patients (27.2 ± 3.5 vs. 38.7 ± 11.5 months, p=.307). Only patients with node-positive disease had a significant OS benefit with the addition of chemotherapy (44.2 ± 7.3 vs. 27.5 ± 10.5 months; p=0.036).

Conclusions: Surgical resection remains the cornerstone of therapy for pACC. Node status and margin status are the primary prognosticators of overall survival. The addition of chemotherapy provides an OS benefit only in node-positive disease.