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

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 dataset. Methods: We queried the National Cancer Database (NCDB) from 2006–2019 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, 8,260 (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 months, 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.