Clinical Diagnosis And Treatment Of Solid Pseudopapillary Neoplasm Of The Pancreas

Objective:Solid pseudopapillary neoplasm of the pancreas(SPN)is a rare exocrine tumor of the pancreas that occurs in young women,and its incidence has been increasing in recent years with the development of diagnostic techniques.Due to the low incidence of SPN and the relatively limited previous data on its clinical features,the results of studies on risk factors for benign and malignant nature are still unclear.In this study,we collected general demographic information,clinical characteristics,treatment and prognosis of SPN patients who visited our hospital in the past 10 years to develop a database of clinical information on this disease and build the foundation for future studies;by describing and summarizing the general demographic characteristics and clinical data of SPN patients,we provide a basis for further understanding of the disease;meanwhile,we analyze the relationship between clinical characteristics such as age,gender,tumor capsule integrity and calcification and the benignity and malignancy of SPN to help screen the high-risk groups of malignant SPN and explore the possibility of optimizing the diagnosis and treatment of SPN with different degrees of malignancy,with a view to guiding the selection of surgical approaches and the development of postoperative review plans.Methods:To retrospectively analyze the data of patients who attended our hospital from May 2013 to September 2022 with postoperative pathologically confirmed diagnosis of SPN,we described and analyzed the clinical characteristics,prognosis,such as age,sex,BMI,laboratory tests,imaging manifestations,and immunohistochemistry.The clinical characteristics were described using mean ± standard deviation or median(interquartile spacing)for quantitative indicators;and number of cases(percentage)for qualitative indicators.Also,the risk factors affecting their benignity and malignancy were explored using logistic regression,and their prognosis was described using Kaplan-Meier curves.Results:1.A total of 195 patients were included in this study,with a median follow-up time of 44.5 months,170 patients were followed up on a regular basis,with a follow-up rate of 87.2%.2.The age range of patients was 9-67 years(median age 27 years),including 163 female patients,with a male to female sex ratio of 1:5.1.the mean age of male patients was 35.09±14.11 years;the mean age of female patients was 31.09±13.67 years.3.Patients mostly had no specific symptoms,and 101 patients(51.8%)were detected by physical examination.The main symptom was abdominal pain and distension in 64 cases(32.8%).Laboratory tests were mostly normal,with only 2 cases(1.1%)with elevated CA199 and 4 cases(2.2%)with elevated CEA.The diagnostic rate of preoperative imaging was 72.8%.4.The maximum diameter of SPN tumors ranged from 1-17 cm(mean 6.19 cm).The tumor location was preferably in the body and tail of pancreas(64.1%).Immunohistochemical results showed mostly positive expression of AACT,Vimentin,PR,Syn,CD10,CD56.5.All patients underwent radical surgery,including 129 laparoscopic surgery(66.2%),and the most common postoperative complication was pancreatic fistula(37.9%).One patient died 15 days after the initial operation,three patients had tumor recurrence and metastasis,two of whom died,and one had a good prognosis after reoperation.The 3-year and 5-year disease-free survival rates were 99.4%and 98.2%after surgery,and the 3-year and 5-year survival rates were 99.4%and 98.8%.6.The incompleteness of tumor capsule was statistically significantly different between benign SPN and malignant SPN,while age,gender,tumor size,and tumor composition were not statistically different between benign SPN and malignant SPN.Conclusions:1.SPN is usually found in young women between the ages of 20-30.SPN has no specific clinical symptoms,mainly abdominal pain and distension.The tumor is usually found in the body and tail of pancreas.Laboratory tests,tumor markers are mostly normal.Preoperative imaging can assist in the diagnosis.2.There are gender differences in the age of onset of SPN:male patients have a unimodal skewness distribution of age of onset,while female patients showed a bimodal distribution with early-onset and late-onset.3.The first choice of treatment for SPN is radical surgical resection,and good prognosis can be obtained with pre-operative metastasis or post-operative recurrent metastasis.4.For malignant SPN,tumor capsule incompleteness is an independent risk factor.For SPN with incomplete tumor capsule detected by preoperative imaging,radical resection should be performed,and long-term postoperative review is recommended.