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.
背景：胰尾癌常伴有脾门侵犯，但其对临床预后的影响尚不明确。本研究旨在探讨脾门侵犯对不可切除胰尾癌患者临床结局的影响。方法：我们回顾性分析了2016年至2020年期间在本机构接受一线治疗的所有不可切除胰尾癌患者。结果：在纳入的111例患者中，48例在确诊时存在脾门侵犯。脾门侵犯与患者年龄较轻、肝转移、腹膜播散、较大肿瘤体积、改良格拉斯哥预后评分≥1分、脾动脉受累、胃静脉曲张及脾肿大显著相关。脾门侵犯患者的中位总生存期（9.3个月 vs 11.6个月，p=0.003）和无进展生存期（4.3个月 vs 6.3个月，p=0.013）均显著缩短。体能状态评分1-2分、肿瘤直径>50毫米、肝转移、改良格拉斯哥预后评分1-2分以及脾门侵犯（风险比：1.65，95%置信区间：1.08-2.52，p=0.020）是总生存期缩短的独立预测因素。脾动脉假性动脉瘤破裂和静脉曲张破裂较为罕见，且仅见于脾门侵犯病例。结论：脾门侵犯与胰尾癌患者不良预后密切相关。
Splenic Hilar Involvement and Sinistral Portal Hypertension in Unresectable Pancreatic Tail Cancer
肿瘤(癌症)患者之家