Hao Emmanuel Ii Uy, Hwang Ho Kyung, Yoon Dong-Sub, Lee Woo Jung, Kang Chang Moo
Department of Surgery, Philippine General Hospital, University of the Philippines, Diliman Quezon City, Philippines.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine.
Medicine (Baltimore). 2018 Dec;97(49):e13147. doi: 10.1097/MD.0000000000013147.
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors considered to be benign although 10% to 15% of SPNs have been reported to be aggressive. Due to its rarity, there have only been a few cases reported regarding the clinical course of patients with aggressive SPNs. The goal of this study is to describe the clinical course of patients diagnosed with aggressive SPNs.
A PubMed search was done looking for articles describing the clinical course of patients diagnosed with SPN that locally invaded, recurred, or metastasized. Institutional experience was also added to the pooled data. Patient information was extracted from the articles. Survival and recurrence curves were plotted and factors associated with survival and recurrences were analyzed.
A total of 59 patients were identified to have aggressive SPN. Seven patients were males and 52 were females and the mean age was 37.44 ± 2.21 years. Systemic metastasis constituted 81.4% while recurrence and deep tissue invasion were found in 11.9% and 6.8% of the patients, respectively. Disease-free survival was 45 ± 6.28 months and disease-specific survival was 152.67 ± 12.8 months. In survival analysis, age, gender, tumor size, tumor location, combined resection, type of recurrence, and stage IV on diagnosis were not significant factors in predicting survival. However, an unresectable tumor (hazards ratio [HR] = 4.871, 95% confidence interval [CI] 1.480-16.03, P = .009), and metastasis within 36 months (HR = 6.399, 95% CI: 1.390-29.452, P = .017) were identified as independent variables in predicting survival.
SPNs of the pancreas carry a favorable course. Despite having aggressive properties, patients can still survive for more than 10 years as long as the tumor can be resected completely.
胰腺实性假乳头状肿瘤（SPNs）是罕见肿瘤，虽被认为是良性的，但据报道10%至15%的SPNs具有侵袭性。由于其罕见性，关于侵袭性SPNs患者临床病程的报道仅有少数病例。本研究的目的是描述诊断为侵袭性SPNs患者的临床病程。
在PubMed上进行检索，寻找描述诊断为局部侵犯、复发或转移的SPNs患者临床病程的文章。机构经验也被纳入汇总数据。从文章中提取患者信息。绘制生存曲线和复发曲线，并分析与生存和复发相关的因素。
共确定59例患者患有侵袭性SPNs。7例为男性，52例为女性，平均年龄为37.44±2.21岁。全身转移占81.4%，而复发和深部组织侵犯分别见于11.9%和6.8%的患者。无病生存期为45±6.28个月，疾病特异性生存期为152.67±12.8个月。在生存分析中，年龄、性别、肿瘤大小、肿瘤位置、联合切除、复发类型和诊断时的IV期不是预测生存的显著因素。然而，不可切除的肿瘤（风险比[HR]=4.871，95%置信区间[CI]1.480-16.03，P=.009）和36个月内发生转移（HR=6.399，95%CI：1.390-29.452，P=.017）被确定为预测生存的独立变量。
胰腺SPNs病程良好。尽管具有侵袭性，但只要肿瘤能完全切除患者仍可存活超过10年。
