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Comparison of Pediatric and Adult Solid Pseudopapillary Neoplasms of the Pancreas
Alicia M Waters1, Robert T Russell1, Ilan I Maizlin1
1Department of Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama.
Insights
Pediatric and adult solid pseudopapillary neoplasms (SPPNs) share similar characteristics and treatments. However, pediatric SPPN patients demonstrate significantly improved overall survival compared to adults, suggesting potential differences in tumor biology.
Area of Science:
- Oncology
- Pediatric Oncology
- Surgical Oncology
Background:
- Solid pseudopapillary neoplasms (SPPNs) are the most common pancreatic tumors in children.
- Existing research lacks comprehensive comparisons between pediatric and adult SPPN patient populations.
Purpose of the Study:
- To compare demographics, tumor characteristics, treatment modalities, and survival outcomes between pediatric and adult patients diagnosed with SPPN.
- To identify potential disparities in SPPN presentation and management across different age groups.
Main Methods:
- Utilized the National Cancer Database (2004-2014) for patient data.
- Stratified patients into pediatric (≤21 years) and adult (≥22 years) groups.
- Employed statistical analyses including t-tests, chi-square, Cox proportional hazard models, and log-rank tests to compare outcomes.
Main Results:
- Analyzed 468 patients (414 in survival analysis); pediatric patients were predominantly female, Caucasian, with stage I disease and no comorbidities.
- Demographics, comorbidities, socioeconomic status, and disease stage were similar between pediatric and adult groups.
- No significant differences observed in treatment initiation, surgical intervention, resection type, chemotherapy, or radiotherapy; however, pediatric SPPNs showed improved overall survival across all stages.
Conclusions:
- Pediatric and adult SPPNs exhibit comparable demographic profiles, tumor characteristics, and treatment approaches.
- Superior survival rates in pediatric SPPN patients suggest underlying differences in tumor biology that may inform prognostic risk stratification.
Background:
Solid pseudopapillary neoplasms (SPPNs) comprise the majority of pediatric pancreatic neoplasms. We queried the National Cancer Database to compare pediatric and adult patients with SSPNs to examine differences in demographics, tumor characteristics, treatment, and overall survival. We aimed to determine if survival differences existed between adult and pediatric patients with SPPN.
Methods:
The National Cancer Database (2004-2014) was reviewed, and patients were stratified by age at diagnosis: pediatric (≤21 y) and adult (≥22 y). Demographics, comorbidities, tumor characteristics, diagnostic periods, treatments, and survival rates were compared using pooled variance t-tests and chi-square, followed by multivariate Cox proportional hazard model (α = 0.05). Log-rank test was used to compare survival.
Results:
A total of 468 patients were analyzed and categorized according to age group. Four hundred and fourteen patients were included in the survival analysis. The pediatric patients were primarily female, Caucasian, had no comorbidities, and presented with stage I disease. Race/ethnicity, gender, socioeconomic status, comorbidities, and disease stage at presentation were similar between the groups. There was no difference in time to initiation of therapy or to surgical intervention. No significant difference was found in type of surgical resection, chemotherapy, or radiotherapy utilization. Despite the similarities between groups, comparison of overall survival demonstrated improved survival of pediatric SPPN compared with adult SPPN in every pathologic stage.
Conclusions:
These results suggest that pediatric and adult SPPNs are similar 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 risk stratification of prognosis.
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