Pancreatic acinar cell carcinoma (PACC): A comparative genomic landscape study.

746 Background: PACC is a rare subtype accounting for ~1% of all exocrine pancreatic neoplasms and remains understudied compared to conventional pancreatic ductal adenocarcinoma (PDAC). Here, we performed a comparative analysis of the genomic landscapes of PACC versus PDAC using the FoundationCORE dataset to identify potential therapeutic vulnerabilities. Methods: Comprehensive genomic profiling using hybrid capture-based next-generation sequencing (NGS) was performed on 196 PACC and 29,493 PDAC tumors to identify pathogenic genomic alterations (GAs). All patients (pts) had stage III/IV disease at the time of profiling. Genomic ancestry, microsatellite instability (MSI), tumor mutational burden (TMB), and homologous recombination deficiency signature (HRDsig) were assessed. Statistical analysis was performed using Fisher’s exact test, with false discovery rate correction applied via the Benjamini-Hochberg method for independent variables or the Benjamini–Yekutieli method for dependent variables. Results: PACC was more common in males than PDAC (67.9% vs 52.7%, p