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. 2023 Dec 15;15(24):5862.
doi: 10.3390/cancers15245862.

Splenic Hilar Involvement and Sinistral Portal Hypertension in Unresectable Pancreatic Tail Cancer

Takeshi Okamoto  1 , Tsuyoshi Takeda  1 , Takafumi Mie  1 , Tatsuki Hirai  1 , Takahiro Ishitsuka  1 , Manabu Yamada  1 , Hiroki Nakagawa  1 , Takaaki Furukawa  1 , Akiyoshi Kasuga  1 , Takashi Sasaki  1 , Masato Ozaka  1 , Naoki Sasahira  1
Affiliations

Splenic Hilar Involvement and Sinistral Portal Hypertension in Unresectable Pancreatic Tail Cancer

Takeshi Okamoto et al. Cancers (Basel). .

Abstract

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.

Keywords: gastric varices; left-sided portal hypertension; pancreatic cancer; spleen; upper gastrointestinal bleeding.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) A case with splenic hilar involvement. (b) A case with no splenic hilar involvement.
Figure 2
Figure 2
A case of gastric variceal rupture. A 39-year-old man with known liver, lung, and bone metastases of pancreatic tail cancer presented with hematemesis. The most recent computed tomography revealed (a) splenic hilar involvement and multiple dilated vessels reaching the surface of the gastric mucosa (arrows) on (b) axial and (c) coronal images. The patient was successfully treated with endoscopic injection sclerotherapy followed by partial splenic embolectomy at a tertiary referral center.
Figure 3
Figure 3
Kaplan–Meier curves comparing (a) overall survival (OS) and (b) progression-free survival (PFS) in patients with and without splenic hilar involvement (SHI). SHI: red curve; no SHI: blue curve. CI: confidence interval.
Figure 4
Figure 4
Kaplan–Meier curves comparing (a) overall survival (OS) and (b) progression-free survival (PFS) in patients with and without gastric varices at diagnosis. Gastric varices: red curve; no gastric varices: blue curve. CI: confidence interval.
See this image and copyright information in PMC

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