Solid Pseudopapillary Tumor of the Pancreas: Is Enucleation Safe?

BACKGROUND: While solid pseudopapillary tumor (SPT) of the pancreas are oncologically low-risk tumors, their resection with pancreaticoduodenectomy (PD) or partial pancreatectomy (PP) carries a significant risk for morbidity. To balance the favorable prognosis with the surgical morbidity of pancreas resection, this study explores the oncologic safety of enucleation (EN). PATIENTS AND METHODS: The National Cancer Database (NCDB) was queried for resected SPT from January 2004 through December 2020. Perioperative outcomes and survival were analyzed with Kruskal-Wallis tests, and Kaplan-Meier analysis (with log-rank test). Survival analysis was performed to compare patients with and without lymph node (LN) metastases and binary logistic regression for predictors of LN metastasis. RESULTS: A total of 922 patients met inclusion criteria; 18 patients (2%) underwent EN, 550 (59.6%) underwent PP, and 354 (38.4%) underwent PD. Mean tumor size was 57.6 mm. Length of hospital stay was significantly shorter for EN compared with PP and PD groups (3.8 versus 6.2 versus 9.4 days, p < 0.001). There was a nonsignificant improvement in unplanned readmission [0% versus 8% versus 10.7% (p = 0.163)], 30-day mortality [0% versus 0.5% versus 0% (p = 0.359)], and 90-day mortality [0% versus 0.5% versus 0% (p = 0.363)] between EN, PP, and PD groups. Survival analyses showed no difference in OS when comparing EN versus PP (p = 0.443), and EN versus PD (p = 0317). Patients with LN metastases (p < 0.001) fared worse, and lymphovascular invasion, higher T category (T3-4) and M1 status were found as predictors for LN metastasis. CONCLUSIONS: EN may be considered for select patients leading to favorable outcomes. Because survival was worse in the rare cohort of patients with LN metastases, the predictors for LN metastasis identified here may aid in stratifying patients to EN versus resection.

Association of Serum Free Light Chain Level with Long Term Kidney Function in Patients with Newly Diagnosed Multiple Myeloma.

INTRODUCTION: Multiple myeloma frequently involves the kidneys, resulting in acute, subacute, or chronic kidney disease. Patient- and treatment-related factors are associated with the long-term development of chronic kidney disease. The aim of our study was to examine the association of serum free light chain (FLC) levels, measured at the time of diagnosis of multiple myeloma, and chronic kidney disease at subsequent follow-up. METHODS: Patients with newly diagnosed multiple myeloma were identified using cancer registries at five hospitals within an integrated healthcare system. Patients without an initial serum FLC level and a baseline and follow-up eGFR were excluded. The primary outcome of interest was an eGFR <60 mL/min/1.73 m2 or dialysis dependence, and a secondary composite outcome of low eGFR, dialysis dependence, or death at the last follow-up, up to 12 months from diagnosis. Logistic regression analyses were performed to examine the association of serum FLC level with the outcomes of interest, after adjustment for several covariates. RESULTS: A total of 300 patients were identified and 149 patients (50%) met the inclusion criteria. The median serum FLC level was 634 mg/L. Patients with a median FLC level above the median had a higher frequency of hypertension (54% vs. 81%; P < 0.001) and hyperlipidemia (37% vs. 56%; P = 0.018) and were more likely to have a low eGFR at the time of diagnosis (43% vs. 66%; P=0.006) and a higher multiple myeloma stage of disease (P=0.018). On multivariable analyses, after adjustment for age, hypertension, chronic kidney disease, FLC subtype, and multiple myeloma stage, serum FLC level (per each 100 mg/L) was independently associated with higher odds for low eGFR or dialysis dependence at follow-up (adjusted odds ratio [OR] 1.021; 95% CI 1.002, 1.041; P=0.033). This association persisted for the composite outcome of low eGFR, dialysis dependence, or death (adjusted OR 1.034; 95% CI 1.006, 1.063; P=0.018). DISCUSSION/CONCLUSION: Higher serum FLC level measured at the time of multiple myeloma diagnosis is independently associated with chronic kidney disease at up to 12 months of follow-up. Additional studies are required to validate these findings.