Sex differences in solid pseudopapillary neoplasm of the pancreas: A population‐based study

Abstract

Objective Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor. This study aims to examine the clinicopathological features and surgical treatments of SPN and compare the clinical behavior and prognosis between men and women with SPN. Methods We collected the population data of patients with SPN diagnosed between 2004 and 2017 from the SEER database. The Kaplan‐Meier method was used to analyze overall survival (OS) and disease‐specific survival (DSS), and log‐rank tests were used to evaluate the differences between subgroups. Univariate and multivariate Cox regression analyses were performed to screen out prognostic risk factors of SPN. Results A total of 378 patients with SPN were included, with 246 (65.1%) female patients. 1‐, 3‐, and 5‐year overall survival rates were 98.9%, 95.7%, and 93.7%, respectively. Survival analysis revealed that regardless of stage, patients with SPN who underwent surgical interventions still had a significantly better prognosis than those without surgical interventions ( P < .001). The patients with lymphatic dissection had a significantly better prognosis than those without lymphatic dissection ( P < .001). Moreover, compared with female patients, male patients had significantly poorer OS and DSS ( P < .001). Female SPN showed a bimodal age‐frequency distribution with early‐onset incidence at 28 years and late‐onset peak incidence at 62 years, while male SPN presented a unimodal distribution with peak incidence at approximately age 64 years. In female patients, the tumor size in premenopausal females (<65 years old) was significantly larger than that in postmenopausal females (≥65 years old) ( P < .001). Clinicopathological characteristic profiles were different not only between male SPN and premenopausal female SPN but also between premenopausal and postmenopausal female SPN. Conclusion SPN presents indolent behavior and predominantly occurs in young women. Regardless of stage, surgical intervention is recommended. Moreover, our study is the first large enough study to demonstrate sex‐related discrepancies in SPN. Thus, different treatment strategies should be designed for patients of different sexes at different ages and hormone therapy is a promising approach for SPN.

Pancreatic solid pseudopapillary neoplasm: a single‐institution study

“…This study supports that SPNs occur more frequently in younger females, with Hanada et al reporting three times higher incidence in females as compared to males, 4 and other studies six times higher in females as compared to males. 5 Interestingly, while premenopausal women have been found to have larger SPN tumours, overall survival and disease-specific survival is significantly worse in men and post-menopausal women, 6 suggesting an oestrogen-dependent tumour biology that warrants further research.…”

Current highlights on solid pseudopapillary neoplasm of the pancreas

“…SPN shows a bimodal incidence in women with two peaks at 28 years and 64 years and a unimodal behavior in men at 64 years[ 8 ]. Furthermore, recent studies described larger masses and more aggressive disease in men and post-menopausal women, suggesting an estrogen dependent behavior of these tumors[ 9 , 10 ]. These findings deserve further investigation in order to find out other possible non-surgical treatment options.…”

Solid bifocal pseudopapillary neoplasm of the pancreas: A case report

“…SPNP is a rare entity, with a frequency of 0.3–2.7% of all pancreatic tumors [ 4 ] and since 2000 its incidence has increased, probably related to a greater use and availability of imaging studies, rather than being a real increase in its incidence [ 5 ]. It has a distal location, an average of 7 cm in diameter at the time of its appearance and a propensity for the female gender, showing a bimodal frequency with a peak at 28 years of age and a late one at 62 years of age, while in men shows a single peak at age 64 [ 6 ].…”

“…Surgical resection, with negative borders, is considered curative in most cases and is associated with an overall survival, at 5 years, of 93.7% [ 6 ]. Although the entity may be indolent at the time of appearance, 10–15% of patients show an aggressive form, with invasion of adjacent organs and distant metastases, or both [ 7 ].…”