Solid Pseudopapillary Neoplasms of the Pancreas Across Races Demonstrate Disparities with Comparably Good Prognosis

Abstract

Background Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare with low‐grade malignancy and unclarified clinicopathological features. This study aimed to examine their characteristics and re‐evaluate current treatments. Methods Databases from three sources were screened for patients with SPNs. We compared the perioperative variables, clinical data, overall survival (OS), and prognostic factors for recurrence among the three corresponding cohorts. Results We identified 286 patients diagnosed with SPNs between 1988 and 2020. Patients were mostly women (81%; median age: 38 years), and peak incidence was observed in women of 20–29 years of age. SPNs had a peak incidence in Asian men at 50–59 years of age (p = 0.002) and a delayed peak incidence in Asian women at 30–39 years of age (p < 0.001). Treatment strategies differed significantly across the institutions and included variations in the number of harvested lymph nodes and rates of vascular resection. Lymph node positivity was the only predictor of postoperative recurrence (odds ratio, 2.2; 95% confidence interval, 1.38–2.99; p = 0.007). Higher rates of lymphovascular invasion (p = 0.02), perineural invasion (p < 0.001), and R1 margin involvement (p < 0.001), as seen in one institution, did not result in poorer long‐term survival in terms of the overall (p = 0.43), SPN‐specific (p = 0.69), and recurrence‐free survivals (p = 0.067). Conclusions In contrast to previous findings that SPNs are prevalent in young women, a racial predilection for middle‐aged Asian men and a delayed female peak incidence were noted. Parenchyma‐preserving pancreatectomy may be an acceptable treatment. Non‐radical surgery may be appropriate in patients with multiple comorbidities.

The World Health Organization classification of pancreaticobiliary cytopathology stratifies risk of malignancy and outcome for endoscopic ultrasound‐guided fine‐needle aspiration of the pancreas

“…Furthermore, these entities have drastically different survival outcomes. For example, solid pseudopapillary neoplasms (SPN) have an approximately 98.9% overall survival 19 . The 5‐year survival of localized and metastatic neuroendocrine tumors (NET) is 83% and 28%, respectively 20 .…”

“…For example, solid pseudopapillary neoplasms (SPN) have an approximately 98.9% overall survival. 19 The 5-year survival of localized and metastatic neuroendocrine tumors (NET) is 83% and 28%, respectively. 20 Yet, as expected, survival was driven primarily by the comparatively high relative incidence and dismal prognosis of pancreatic adenocarcinoma with a worldwide 5-year survival of 9%.…”

Pancreatic Cancer Health Disparity: Pharmacologic Anthropology

“…The scope of pharmacologic anthropology in the context of cancer in general and PCa specifically is broad and encompasses several aspects such as cultural and behavioral factors, socioeconomic factors, access to healthcare and treatment disparities, as well as genetic and biological factors. It investigates the impact of cultural norms and traditions on treatment-seeking behaviors [16], patient adherence to prescribed medications [17], and acceptance of alternative or complementary therapies [18,19]. This field explores the role of socioeconomic disparities in the prevention, diagnosis, and treatment of PCa.…”