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DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens

DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens

Published on: February 1, 2020

Presentation, Management, and Outcomes of Cyst-Associated Pancreatic Cancer Versus Classic Pancreatic Ductal

Timothy E Newhook¹, Michael P Kim, Belkacem Acidi

¹Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.

|December 12, 2025

Abstract

Background:

Mucinous cyst-associated pancreatic cancer (CA-PC) outcomes are varied. This study compares the presentation, management, and outcomes of CA-PC with classic pancreatic ductal adenocarcinoma (PDAC) using a national data set.

Methods:

We queried the National Cancer Database (NCDB) from 2006 to 2019 for patients with AJCC Stage I-IV CA-PC and PDAC using histologic codes. Clinicopathologic characteristics and outcomes were analyzed, and overall survival (OS) was compared using Kaplan-Meier and Cox proportional hazard models.

Results:

Among 239,563 patients, 8260 (4%) had CA-PC, while 231,303 (97%) had PDAC. CA-PC was diagnosed at earlier stages (Stage II-IV: 66% vs. 76%, P <0.001), with more patients undergoing pancreatectomy (34% vs. 24%, P <0.001). CA-PC patients more frequently had upfront surgery (91.% vs. 76%, P <0.001) but less chemotherapy (55% vs. 75%, P <0.001) and radiation (23% vs. 33%, P <0.001). Median OS after resection was longer for CA-PC (43.2 vs. 22.9 mo, P <0.001). CA-PC was associated with improved survival in stages I (HR: 0.49) and II (HR: 0.73), but not in stage III (HR: 1.07).

Discussion:

CA-PC has a better prognosis than PDAC in early stages but not in advanced disease, offering important insights for therapeutic strategies.

Keywords:

adenocarcinoma cyst-associated pancreatic cancer mucinous cyst pancreatic cancer pancreatic cyst

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Keywords:

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