Identification of high-risk features in mucinous cystic neoplasms of the pancreas.

Autor: Servin-Rojas M; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/servinrojasmd., Fong ZV; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/ZhiVenFongMD., Fernandez-Del Castillo C; Department of Surgery, Massachusetts General Hospital, Boston, MA., Ferrone CR; Department of Surgery, Massachusetts General Hospital, Boston, MA., Rocha-Castellanos DM; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/dariorochamd., Roldan J; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/md_roldan., Zelga PJ; Department of Surgery, Massachusetts General Hospital, Boston, MA., Warshaw AL; Department of Surgery, Massachusetts General Hospital, Boston, MA., Lillemoe KD; Department of Surgery, Massachusetts General Hospital, Boston, MA., Qadan M; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: mqadan@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2023 May; Vol. 173 (5), pp. 1270-1274. Date of Electronic Publication: 2023 Feb 21.
DOI: 10.1016/j.surg.2023.01.011
Abstrakt: Background: Mucinous cystic neoplasms of the pancreas are uncommon tumors that have the potential of becoming cancer. There is no consensus regarding the high-risk features of these tumors. Our study aimed to identify the preoperative demographic, clinical, or radiologic factors that can predict the presence of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas.
Methods: We identified 157 patients who underwent resection and fulfilled the pathologic criteria for mucinous cystic neoplasms of the pancreas in a prospectively maintained database spanning 3 decades (1990-2020). Multivariable logistic regression was used to identify predictors of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas.
Results: The rate of high-grade dysplasia or invasive carcinoma was 11%. Tumor size ≥4 cm (P < .001), mural nodularity (P = .04), and a serum CA 19-9 level >37 U/mL (P < .001) were associated with high-grade dysplasia or invasive carcinoma. In the multivariable analysis, tumor size ≥4 cm (odds ratio 16.9, 95% confidence interval 2.04-140, P = .009) and a CA 19-9 level >37 U/mL (odds ratio 5.68, 95% confidence interval 1.52-21.3, P = .010) were predictors of high-grade dysplasia or invasive carcinoma. There were no tumors with high-grade dysplasia or invasive carcinoma in patients with tumor size <4 cm in the absence of an elevated CA 19-9 or mural nodularity.
Conclusion: Tumors with a size ≥4 cm and/or a high CA 19-9 level should be considered for prompt surgical resection. Conversely, tumors <4 cm with no other high-risk features have a negligible risk for high-grade dysplasia or invasive carcinoma and may benefit from nonoperative surveillance. Mural nodularity is an additional suspicious feature. These findings may contribute to future guidelines.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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