title: Analysis of 340 Patients with Solid Pseudopapillary Tumors of the Pancreas: A Closer Look at Patients with Metastatic Disease.
abstract: BACKGROUND
  Current literature addressing the treatment of solid pseudopapillary neoplasms (SPNs) of the pancreas is limited, particularly for patients with distant metastases. We aimed to define predictive indicators of survival in a large series of patients and assess the outcome of patients with distant metastases.
  
  
  METHODS
  The National Cancer Database was queried for patients diagnosed with SPNs of the pancreas between 1998 and 2011. Single predictor univariate analyses were performed on variables including demographics, tumor characteristics, and surgery outcomes, and multivariate Cox proportional hazards survival analysis was then completed with backward elimination.
  
  
  RESULTS
  Overall, 340 patients were identified: 82% were female, median age was 39 years, and 84% had no comorbidities. Patients undergoing any type of surgical resection experienced long-term survival (85% 8-year survival). Patients undergoing surgical resection (n = 296) had superior survival (hazard ratio [HR] 21 for no surgery, p < 0.0001), as did patients treated at academic centers and those with private insurance (HR 3.9, p = 0.009; HR 4.9, p = 0.007). Sex, age, tumor size, presence of lymph node metastases, positive surgical margins, and presence of distant metastases were not significant predictors of survival in multivariate analysis. Of 24 patients with distant metastases, seven were treated surgically and experienced long-term survival similar to that of patients without metastases treated surgically (HR 2, p = 0.48).
  
  
  CONCLUSIONS
  SPNs of the pancreas are rare neoplasms with excellent overall survival; however, in a low number of patients they metastasize. Of the few patients with metastatic disease selected for resection, most experienced long-term survival.
authors.affiliation: Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Jutric
authors.affiliation: Providence Health and Services, Renton, WA, USA.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rozenfeld
authors.affiliation: Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Grendar
authors.affiliation: Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA.
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.affiliation: Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.affiliation: Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.|Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA.
authors.forename: Pippa H
authors.initials: PH
authors.lastname: Newell
authors.affiliation: Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.|Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
authors.affiliation: Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA. rwolf@orclinic.com.|Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA. rwolf@orclinic.com.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Wolf
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D010180:Pancreatectomy / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden