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Fu C, Li X, Wang Y, Wang C, Jin H, Liu K, Xu H. Solid pseudopapillary neoplasm of the pancreas: a retrospective study of 195 cases. Front Oncol 2024; 14:1349282. [PMID: 38469229 PMCID: PMC10925641 DOI: 10.3389/fonc.2024.1349282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare exocrine tumor of the pancreas. The aim of our study is to summarize the clinical features of SPN and to analyze the risk factors for malignant SPN. Methods From May 2013 to September 2022, patients who were pathologically confirmed to have SPN were retrospectively reviewed. Demographic data, clinical and pathological features, follow-up data were collected and analyzed. To investigate the factors influencing the benign or malignant nature of SPN, we employed logistic regression. Additionally, we utilized Kaplan-Meier curves to depict and analyze the overall prognosis. Results A total of 195 patients were included, 163 of whom were female and the average age of all patients was 31.7 years old. Among 195 patients, 101 patients (51.8%) had no obvious clinical symptoms and their pancreatic lesions were detected during routine examination. The primary symptom was abdominal pain and distension in 64 cases (32.8%). The maximum diameter of SPN tumors ranged from 1-17 cm (mean 6.19 cm). Forty-eight postoperative complications developed in 43 (22.1%) patients. After a median follow-up duration of 44.5 months, the overall 5-year survival rate was 98.8% and the recurrence rate was 1.5%. Furthermore, we observed a statistically significant difference in the completeness of the tumor capsule between benign and malignant SPN. Conclusion SPN is associated with a favorable long-term survival after surgery in our large sample size cohort. For malignant SPN, tumor capsule incompleteness is an independent risk factor.
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Affiliation(s)
- Chang Fu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaocong Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongxin Wang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Chuangshi Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengwei Jin
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kai Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongji Xu
- Department of Abdominal Surgery, Guiqian International General Hospital, Guiyang, Guizhou, China
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Standring O, Benitez Sanchez S, Pasha S, Demyan L, Lad N, Ruff SM, Anantha S, Karpeh M, Newman E, Nealon W, Talamini M, Coppa G, Deutsch G, Weiss M, DePeralta DK. Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN). Ann Surg Oncol 2023; 30:5105-5112. [PMID: 37233954 DOI: 10.1245/s10434-023-13496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPN) are rare tumors of the pancreas, typically affecting young women. Resection is the mainstay of treatment but is associated with significant morbidity and potential mortality. We explore the idea that small, localized SPN could be safely observed. METHODS This retrospective review of the Pancreas National Cancer Database from 2004 to 2018 identified SPN via histology code 8452. RESULTS A total of 994 SPNs were identified. Mean age was 36.8 ± 0.5 years, 84.9% (n = 844) were female, and most had a Charlson-Deyo Comorbidity Coefficient (CDCC) of 0-1 (96.6%, n = 960). Patients were most often staged clinically as cT2 (69.5%, n = 457) followed by cT3 (17.6%, n = 116), cT1 (11.2%, n = 74), and cT4 (1.7%, n = 11). Clinical lymph node and distant metastasis rates were 3.0 and 4.0%, respectively. Surgical resection was performed in 96.6% of patients (n = 960), most commonly partial pancreatectomy (44.3%) followed by pancreatoduodenectomy (31.3%) and total pancreatectomy (8.1%). In patients clinically staged as node (N0) and distant metastasis (M0) negative, occult pathologic lymph node involvement was found in 0% (n = 28) of patients with stage cT1 and 0.5% (n = 185) of patients with cT2 disease. The risk of occult nodal metastasis significantly increased to 8.9% (n = 61) for patients with cT3 disease. The risk further increased to 50% (n = 2) in patients with cT4 disease. CONCLUSIONS Herein, the specificity of excluding nodal involvement clinically is 99.5% in tumors ≤ 4 cm and 100% in tumors ≤ 2 cm. Therefore, there may be a role for close observation in patients with cT1N0 lesions to mitigate morbidity from major pancreatic resection.
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Affiliation(s)
- Oliver Standring
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | | | - Shamsher Pasha
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Lyudmyla Demyan
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Neha Lad
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Samantha M Ruff
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Sandeep Anantha
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Martin Karpeh
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Huntington Hospital, Huntington, NY, USA
| | - Elliot Newman
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - William Nealon
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mark Talamini
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gene Coppa
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gary Deutsch
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Matthew Weiss
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle K DePeralta
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA.
- Northwell Health Cancer Institute, Lake Success, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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