Adenosquamous Carcinoma of the Pancreas: Outcomes of a Multicenter European Study (ADESQUPAN Project)

BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer. Compared with other pancreatic tumors, ASCP has a notably poorer prognosis and shorter survival rates. The optimal therapeutic approaches to ASCP have yet to be defined. METHODS: This retrospective, multicenter European study included all consecutive patients who underwent elective pancreatic surgery for ASCP at participating centers between 2010 and 2024. The inclusion criteria encompassed all patients who underwent scheduled surgery for ASCP during the study period. The exclusion criteria ruled out patients without a confirmed pathologic diagnosis of ASCP, those who did not undergo surgery, and patients with extra-pancreatic disease. RESULTS: The study analyzed 194 patients from 29 hospitals in 11 European countries. The overall survival rates were 56.2% at 1 year, 26.3% at 3 years, and 9.8% at 5 years. The disease-free survival rates at the same intervals were 36.6%, 16.5%, and 6.7%, respectively. In the multivariate analysis, significant associations with shorter survival were R2 resections, lymphatic stromal invasion, T4 stage, no adjuvant chemotherapy, and recurrence. CONCLUSIONS: Patients who undergo resection for ASCP experience very low 5-year survival rates (10%). It is advisable to avoid resecting T4 tumors in patients with significant comorbidities or R2 resections. Additionally, failure to provide adjuvant chemotherapy, often due to severe postoperative complications, further deteriorates the prognosis.