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MALIGNANT CYSTIC NEOPLASMS OF PANCREAS: A SITE-SPECIFIC ANALYSIS OF THE SEER DATABASE
Zhamak Khorgami2, Timothy Jorgenson1, Timothy M. Hughes*2, Guido Sclabas2
1Internal medicine, Northshore-LIJ, New Hyde Park, NY; 2Surgery, University of Oklahoma - Tulsa, Tulsa, OK
Background & Aims: Pancreatic cystic neoplasms can be premalignant or malignant making their diagnostic approach and management challenging. We studied malignant cystic lesions of the pancreas and their survival using the Surveillance, Epidemiology, and End Results (SEER) cancer registry database.
Methods: Malignant cystic pancreatic lesions were extracted from the National Cancer Institute SEER database based on ICD-O-3 codes. Carcinoma in situ lesions and cases without microscopic confirmation were excluded. Malignant cystic lesions were categorized into mucinous, serous, intraductal papillary mucinous, and solid pseudopapillary carcinoma. Kaplan-Meier survival analysis and log rank test were used to compare survival between different groups, adjusted for TNM stage, and also were compared to pancreatic adenocarcinoma and solid mucinous carcinoma as the more common malignant pancreatic lesions.
Results: Out of 221,567 pancreatic lesions, 1,256 patients had malignant cystic lesions (581 mucinous, 210 serous tumors, 280 intraductal papillary mucinous carcinomas, and 185 solid pseudopapillary carcinomas). Solid pseudopapillary carcinoma and IPMN with malignancy have been increasingly diagnosed after 2000. Solid pseudopapillary carcinoma had the best mean survival of 41.3 months followed by IPMN with malignancy (30.2 months), malignant cystic mucinous lesions (28.6 months), and malignant cystic serous neoplasms (21.7 months). Pancreas adenocarcinoma and solid mucinous carcinoma had the worst mean survival of 7 and 8 months, respectively.
Conclusion: Malignant cystic neoplasms of the pancreas are increasingly diagnosed and need to be emphasized in continuing medical education. Their long-term survival is poor, although they show a better survival than pancreatic adenocarcinoma. Malignant serous cystic neoplasm of the pancreas has the worst survival among cystic lesions of the pancreas.
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