L. M. Youngwirth1, D. P. Nussbaum1, E. Benrashid1, B. C. Gulack1, D. G. Blazer1 1Duke University Medical Center,Durham, NC, USA
Introduction: Primary solid pseudopapillary tumors of the pancreas are rare and typically present in young women. Data regarding the outcomes of adult patients with these tumors are limited. The purpose of this study was to determine the presentation, oncologic profile, and survival of this patient population utilizing a large national database.
Methods: The National Cancer Data Base (1998-2012) was queried for all adult patients with a diagnosis of a solid pseudopapillary tumor of the pancreas. Patient demographic, clinical, and pathologic characteristics at the time of diagnosis were determined. A binary logistic regression model was utilized to identify variables associated with resection. A Cox proportional hazards model was developed to identify factors associated with survival.
Results: A total of 390 patients met inclusion criteria. The mean age at diagnosis was 40 years with the majority of tumors occurring in females (83.3%) and those of white race (68.8%). The mean tumor size was 6.7 cm and the majority of patients underwent surgical resection (87.4%). Of the 341 patients undergoing surgical resection, 2.9% underwent local excision, 11.1% underwent total pancreatectomy, 33.5% underwent pancreaticoduodenectomy, and 52.5% underwent partial pancreatectomy. Of the patients undergoing surgical resection, 8.5% had positive lymph nodes and 8.7% had positive margins. Five year survival was 49.7% for those who did not undergo resection compared to 95.0% for those who did undergo resection (p < 0.01). After adjustment, decreasing patient age (OR = 1.37, p < 0.01), decreasing tumor size (OR = 1.02, p < 0.01), and tumors located in the body or tail of the pancreas (OR = 2.38, p = 0.02) predicted resection. For patients undergoing resection, increasing patient age (HR = 1.49, p = 0.04) and treatment at a non-academic facility (HR = 3.23, p = 0.03) were associated with compromised survival after adjustment. Tumor size, lymph node status, and margin status were not independently associated with survival.
Conclusion: Patients who underwent resection had excellent overall survival. Of patients undergoing resection, increasing age and treatment at a non-academic facility were associated with compromised survival. Given these outcomes and the established importance of facility experience for pancreatic resection, adult patients with primary solid pseudopapillary tumors of the pancreas are ideally suited for referral to highly experienced centers.