R. T. Russell1, I. I. Maizlin1, M. B. Dellinger2, K. W. Gow2, A. B. Goldin2, M. Goldfarb3, J. J. Doski4, A. Gosain8, M. Langer7,8, M. V. Raval6, J. G. Nuchtern5, S. A. Vasudevan5, E. A. Beierle1 1University Of Alabama at Birmingham,Pediatric Surgery,Birmingham, Alabama, USA 2Seattle Children’s Hospital,Pediatric Surgery,Seattle, WA, USA 3John Wayne Cancer Institute At Providence St. John’s Health Center,Surgery,Santa Monica, CA, USA 4Methodist Children’s Hospital Of South Texas, University Of Texas Health Science Center-San Antonio,Surgery,San Antonio, TX, USA 5Baylor College Of Medicine, Texas Children’s Hospital,Pediatric Surgery,Houston, TX, USA 6Emory University School Of Medicine, Children’s Healthcare Of Atlanta,Pediatric Surgery,Atlanta, GA, USA 7Maine Children’s Hospital, Tufts University,Surgery,Portland, ME, USA 8University Of Tennessee Heath Science Center,Pediatric Surgery,Memphis, TN, USA
Introduction: Solid pseudopapillary neoplasms (SPPN) are rare pancreatic neoplasms. While constituting only 1-3 % of pancreatic tumors, they comprise the majority (71%) of pediatric pancreatic neoplasms. To our knowledge, there have been no large scale comparative studies between pediatric and adult SPPN. Therefore, we, queried the National Cancer Data Base (NCDB) to compare pediatric and adult patients with SSPN diagnosis, to examine differences in demographics, tumor characteristics, treatment modalities and overall survival. We aimed to determine if survival differences existed between adult and pediatric patients with SPPN.
Methods: The NCDB (2004-2014) was reviewed for cases of pancreatic SPPN. Patients were stratified by age at diagnosis: pediatric (≤21 years) and adult (≥22 years). Once cases lacking survival data were excluded from analysis, demographics, comorbidities, tumor characteristics, diagnostic periods, treatments, and survival rates were compared using pooled variance t-tests and χ2, followed by multivariate Cox proportional hazard model (α=0.05). Log-rank test was used to compare survival.
Results: 468 patients with SPPN were analyzed and categorized according to age-group (pediatric: N=80; adult: N=388). 414 patients (pediatric=61; adult=334) were included in the survival analysis as 54 patients had incomplete survival data, with all 414 utilized in the multivariate analysis. The pediatric patients were primarily female (91%), non-Hispanic White (55%), had no comorbidities (89%), and presented with Stage I disease (59%). Race/ethnicity (p=0.130), gender (p=0.064), socioeconomic status (income: p=0.827; education: p=0.891; insurance status: p=0.933), comorbidities (p=0.136), and disease stage at presentation (p=0.359) were similar between the groups. Following diagnosis, there was no difference in time to initiation of therapy (p=0.083) or time to surgical intervention (p=0.058). No significant difference was found between the groups in type of surgical resection, chemotherapy (p=0.059), or radiotherapy (p=0.082) utilization. Despite the similarities between the age groups, comparison of overall survival (Figure 1) demonstrated improved survival of pediatric SPPN as compared to adult SPPN in every pathologic stage (Stage I: p< 0.001, Stage II: p= 0.045, Stage III: p= 0.018, Stage IV: p=0.009 ).
Conclusions: The results of the current study suggest that pediatric SPPNs are similar to those in adults with regards to demographics, tumor characteristics, and treatment modalities. However, survival was better in children with SPPNs, which may be due to differences in tumor biology and may serve for evidence-based risk stratification of prognosis.
