Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Mod Pathol. 2023 Jun;36(6):100141. doi: 10.1016/j.modpat.2023.100141. Epub 2023 Feb 20.
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare. They are considered low-grade malignancies, and a small percentage of patients experience recurrence or metastasis. It is critical to investigate associated biological behavior and identify patients at a risk of relapse. This was a retrospective study of 486 patients with SPNs who were diagnosed between 2000 and 2021. Their clinicopathologic features, including 23 parameters and prognoses were analyzed. Six patients (1.2%) presented with synchronous liver metastasis. A total of 21 patients experienced recurrence or metastasis postoperatively. The overall and disease-specific survival rates were 99.8% and 100%, respectively. The 5- and 10-year relapse-free survival (RFS) rates were 97.4% and 90.2%, respectively. Tumor size, lymphovascular invasion, and the Ki-67 index were independent predictors of relapse. Furthermore, a Peking Union Medical College Hospital-SPN risk model was built to evaluate the risk of relapse and compared it with the American Joint Committee on Cancer tumor staging system (eighth edition, 2017). Risk factors included 3 parameters: tumor size (>9 cm), lymphovascular invasion status (presence), and Ki-67 index (>1%). Risk grades were available for 345 patients, who were divided into 2 groups: (1) low risk (n = 124) and (2) high risk (n = 221). The group with no risk factors was designated as low risk and had a 10-year RFS of 100%. The group associated with 1 to 3 factors was designated as high risk, with a 10-year RFS of 75.3%. Receiver operating characteristic curves were generated, and the area under the curve was 0.791 for our model and 0.630 for the American Joint Committee on Cancer with respect to the cancer staging system. We validated our model in independent cohorts and demonstrated a sensitivity of 98.3%. In conclusion, SPNs are low-grade malignant neoplasms that rarely metastasize, and the 3 selected pathologic parameters can be used to predict their behavior. A novel Peking Union Medical College Hospital-SPN risk model was proposed for routine application to guide the patient counseling in clinical practice.
胰腺实性假乳头状瘤（SPN）较为罕见，属于低度恶性肿瘤，仅有小部分患者会出现复发或转移。因此，探究其相关生物学行为，明确易复发患者的特征十分重要。本研究回顾性分析了 2000 年至 2021 年间收治的 486 例 SPN 患者的临床病理特征，包括 23 项参数和预后情况。6 例（1.2%）患者伴有同步肝转移，21 例患者术后出现复发或转移。总体和疾病特异性生存率分别为 99.8%和 100%，5 年和 10 年无复发生存率分别为 97.4%和 90.2%。肿瘤大小、脉管侵犯和 Ki-67 指数是独立的复发预测因素。此外，还构建了一套包含 3 项参数（肿瘤大小＞9cm、脉管侵犯和 Ki-67 指数＞1%）的北京协和医院 SPN 风险模型，并与美国癌症联合委员会肿瘤分期系统（2017 年第八版）进行了比较。风险分级适用于 345 例患者，分为低危（124 例）和高危（221 例）两组。无危险因素的患者被定义为低危，其 10 年无复发生存率为 100%；存在 1~3 个危险因素的患者为高危，其 10 年无复发生存率为 75.3%。绘制了受试者工作特征曲线，本模型的曲线下面积为 0.791，美国癌症联合委员会肿瘤分期系统的曲线下面积为 0.630。我们在独立队列中验证了该模型，其敏感度为 98.3%。综上所述，SPN 为低度恶性肿瘤，转移率低，3 项选定的病理参数可用于预测其行为。本研究提出了一种新的北京协和医院 SPN 风险模型，可用于常规临床实践，为患者咨询提供指导。
