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Comprehensive study of clinical features, prognostic factors, and survival in patients with pancreatic solid pseudopapillary neoplasms based on the 2019 WHO classification

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Abstract

Background

Pancreatic solid pseudopapillary neoplasms (pSPNs) are a rare tumor type with a limited understanding of their clinical characteristics and survival outcomes. We aimed to investigate potential prognostic factors among the existing clinical features in patients diagnosed with pSPN.

Methods

For this study, we utilized data from the Surveillance Epidemiology and End Results (SEER) database, specifically selecting patients with a histology type of pSPN from the years 2000 to 2019. Subsequently, we conducted both univariate and multivariate Cox regression analyses in a systematic manner to identify potential prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS) in the selected group of patients. To assess the disparity in OS and CSS among different clinical features and treatments, Kaplan–Meier curves were generated. Furthermore, utilizing the results obtained from the multivariate analysis, we developed a nomogram predictive model to effectively forecast the prognosis of patients diagnosed with pSPN. Calibration plots were presented to demonstrate the predictive accuracy and reliability of the nomogram predictive model.

Results

The study comprised a total of 433 participants, with 85.7% of the patients diagnosed with pSPN being female and the remaining 14.3% being male. The Kaplan–Meier curves indicated that patients with pSPN who underwent primary tumor resection (PTR) and those who were younger than 70 years old had significantly improved OS and CSS compared to those who did not undergo PTR or were aged 70 years or older, respectively (P < 0.001). Male patients diagnosed with pSPN exhibited poor OS compared to female pSPN patients (P = 0.015). The multivariate Cox regression analysis indicated that age (OS: HR = 1.055, 95% CI = 1.027–1.084, P < 0.001. CSS: HR = 1.054, 95% CI = 1.019–1.091, P = 0.002) and PTR (OS: HR = 6.074, 95% CI = 1.922–19.194, P = 0.002. CSS: HR = 4.912, 95% CI = 1.188–20.312, P = 0.028) were independent prognostic factors for both OS and CSS. Moreover, tumor size (≥ 5 vs < 5 cm CSS: HR = 4.788, 95% CI = 1.012–22.661, P = 0.048) was an independent prognostic factor for CSS. The independent prognostic factors identified through the multivariate Cox regression analysis were utilized to construct a nomogram model for predicting both OS and CSS in patients with pSPN. The accuracy of the nomogram model was visually testified by the calibration plot with acceptable predictive performance.

Conclusion

Although the majority of patients diagnosed with pSPN are females, it was observed that male patients tend to have poorer OS compared to their female counterparts. The independent prognostic factors identified in the study were age and PTR, which were associated with both OS and CSS. Tumor size was an independent prognostic factor for CSS. Patients who underwent PTR exhibited improved OS and CSS outcomes. The developed nomogram and corresponding reference table provided promising prognostic predictions for pSPN outcoms, serving as a valuable resource for clinicians and patients alike.

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Data availability statement

The SEER database, a repository of cancer data managed by the US National Cancer Institute, provided all the data used in this study.

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Acknowledgements

We express our gratitude to the SEER database founders and data providers for making this study possible. Additionally, we appreciate their contribution in making the SEER database available to us. We would like to thank all the editors and reviewers who participated in the review. We also acknowledge the valuable role played by the clinic staff and managers of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College in this research.

Funding

Research grant supports were provided by the National Key R&D Program of China (2018YFE0118600); National Natural Science Foundation of China (No.81972258, No.81974376, No. 82103016, No. 82172836, No.82272917, No.82203158); CAMS Innovation Fund for Medical Sciences (CIFMS) (2021–1-I2M-002); China Postdoctoral Science Foundation (2021T140071 and 2021M690462); Youth Research Fund of Peking Union Medical College Hospital (pumch201911710, pumch201910819); National High Level Hospital Clinical Research Funding (2022-PUMCH-A-056; 2022-PUMCH-A-133; 2022-PUMCH-A-245) National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Building Project for Major Diseases.

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Authors and Affiliations

  1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Wenhao Luo, Hao Chen, Jun Wang, Jiangdong Qiu & Taiping Zhang

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  1. Wenhao Luo
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  2. Hao Chen
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  3. Jun Wang
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  4. Jiangdong Qiu
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  5. Taiping Zhang
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Contributions

LWH searched the data, analyzed the data and finished the manuscript. CH, WJ, and QJD assisted in revising the manuscript. ZTP reviewed and supervised the project.

Corresponding author

Correspondence to Taiping Zhang.

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Conflict of interest

We declare no competing interest in the study.

Ethical approval and consent to participate

Data extracted from the SEER database required no relevant approval for this study as per Peking Union Medical College Hospital's policy.

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Luo, W., Chen, H., Wang, J. et al. Comprehensive study of clinical features, prognostic factors, and survival in patients with pancreatic solid pseudopapillary neoplasms based on the 2019 WHO classification. J Cancer Res Clin Oncol 149, 12393–12404 (2023). https://doi.org/10.1007/s00432-023-04982-x

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