학술논문
Splenic Hilar Involvement and Sinistral Portal Hypertension in Unresectable Pancreatic Tail Cancer.
Document Type
Article
Author
Source
Subject
*PANCREATIC tumors
*STATISTICS
*CONFIDENCE intervals
*GASTROINTESTINAL hemorrhage
*RETROSPECTIVE studies
*ACQUISITION of data
*METASTASIS
*ESOPHAGEAL varices
*REGRESSION analysis
*SPLEEN diseases
*MEDICAL records
*GLASGOW Coma Scale
*KAPLAN-Meier estimator
*DESCRIPTIVE statistics
*SPLEEN
*PORTAL hypertension
*SPLENIC artery
*PROGRESSION-free survival
*DATA analysis
*DATA analysis software
*OVERALL survival
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
2072-6694
Abstract
Simple Summary: Pancreatic cancer can be categorized into pancreatic head, body, and tail cancer, all of which carry a grim prognosis. Pancreatic tail cancer frequently invades the splenic hilum and splenic vein. It is currently unclear whether splenic hilar involvement is associated with a poor prognosis. Splenic vein occlusion can also lead to sinistral portal hypertension, which can in turn give rise to gastric varices. The clinical impact of sinistral portal hypertension and hemorrhagic events has yet to be elucidated. In this study, we explore the effect of splenic hilar involvement and sinistral portal hypertension on outcomes in patients with pancreatic tail cancer. The results of this study may contribute to better prediction of outcomes and assist physicians in the education and care of their patients. Background: Pancreatic tail cancer (PTC) frequently displays splenic hilar involvement (SHI), but its impact on clinical outcomes remains unclear. We investigated the clinical impact of SHI in patients with unresectable PTC. Methods: We retrospectively reviewed all patients with unresectable PTC who received first-line therapy at our institution from 2016 to 2020. Results: Of the 111 included patients, 48 had SHI at diagnosis. SHI was significantly associated with younger age, liver metastasis, peritoneal dissemination, larger tumor size, modified Glasgow prognostic score of 1 or more, splenic artery involvement, gastric varices, and splenomegaly. Shorter median overall survival (OS; 9.3 vs. 11.6 months, p = 0.003) and progression-free survival (PFS; 4.3 vs. 6.3 months, p = 0.013) were observed in SHI patients. Poor performance status of 1 or 2, tumor size > 50 mm, hepatic metastasis, mGPS of 1 or 2, and SHI (hazard ratio: 1.65, 95% confidence interval: 1.08–2.52, p = 0.020) were independent predictors of shorter OS. Splenic artery pseudoaneurysm rupture and variceal rupture were rare and only observed in cases with SHI. Conclusions: Splenic hilar involvement is associated with worse outcomes in pancreatic tail cancer. [ABSTRACT FROM AUTHOR]