Predicting Recurrence of Pancreatic Solid Pseudopapillary Tumors After Surgical Resection A Multicenter Analysis in Korea
Predicting Recurrence of Pancreatic Solid Pseudopapillary Tumors After Surgical Resection A Multicenter Analysis in Korea
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DOI：
10.1097/sla.0000000000000583
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发表时间：
2014-08-01
影响因子：
9
通讯作者：
Kim, Sun Whe
中科院分区：
文献类型：
--
作者：
Kang, Chang Moo;Choi, Sung Hoon;Kim, Sun Whe
背景：胰腺实性假乳头状瘤（SPTs）仍然被认为是一个外科学上的谜。许多临床研究试验未能确定预后因素预测恶性行为的SPTs.Materials和方法：这项工作是一项回顾性多中心研究，共包括17个医疗机构。从1990年1月至2008年12月接受手术切除的351例患者的数据进行了回顾性收集，使用标准化的病例报告表，要求clinical pathological features.Results：34例（9.7%）为男性，317例（90.3%）为女性，平均年龄为36.8 ± 12.4岁。近年来，微创（P < 0.001）和保留实质或功能的有限手术（P = 0.016）更常用于治疗胰腺SPT。98例患者（27.9%）有显微镜下恶性特征。仅9例患者（2.6%）在初次胰腺SPT切除术后发生肿瘤复发。多变量分析显示，肿瘤尺寸大于8 cm [Exp（beta）= 7.385，P = 0.018]、显微镜下恶性特征[Exp（beta）= 10.009，P = 0.011]和IV期[Exp（beta）= 42.003，P = 0.002]是肿瘤复发的重要预后因素。结合IV期，根据病理学恶性程度和2010年WHO对实性假乳头状癌的定义，可更好地区分未来复发风险组（P <0. 001）。结论：病理报告表中需要采用更具体的病理描述，以提供正确的信息来预测SPT切除后的复发。未来的研究强调胰腺SPT的标准化病理评价，可能会揭示胰腺SPT的神秘本质。
Background: Solid pseudopapillary tumors (SPTs) of the pancreas are still considered a surgical enigma. Many clinical research trials have failed to identify prognostic factors that predict the malignant behavior of SPTs.Materials and Methods: This work was a retrospective multicenter study that included a total of 17 medical institutions. Data from 351 patients who underwent surgical resection from January 1990 to December 2008 were retrospectively collected using standardized case report forms requesting clinicopathologic features.Results: Thirty-four patients (9.7%) were male, and 317 (90.3%) were female, with a mean age of 36.8 +/- 12.4 years. Recently, minimally invasive (P < 0.001) and parenchyma or function-preserving limited surgeries (P = 0.016) have been more frequently applied for the treatment of pancreatic SPTs. Ninety-eight patients (27.9%) had microscopic malignant features. Only 9 patients (2.6%) experienced tumor recurrence after the initial pancreatic SPT resection. Multivariate analysis showed that a tumor size larger than 8 cm [Exp (beta) = 7.385, P = 0.018], microscopic malignant features [Exp (beta) = 10.009, P = 0.011], and stage IV [Exp (beta)= 42.003, P = 0.002] were significant prognostic factors for tumor recurrence. When combined with stage IV, the microscopic malignant features and 2010 World Health Organization definition of solid pseudopapillary carcinoma more successfully differentiated future recurrence risk groups (P < 0.001).Conclusions: More specific pathologic descriptions need to be employed in pathologic report forms to provide proper information to predict SPT recurrence after resection. Future studies emphasizing the standardized pathologic evaluation of pancreatic SPTs may unveil the enigmatic nature of pancreatic SPTs.