Hoffman Rebecca L, Gates Jenna L, Kochman Michael L, Ginsberg Gregory G, Ahmad Nuzhat A, Chandrasekhara Vinay, Furth Emma E, Vollmer Charles M, Drebin Jeffrey A
Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA.
J Am Coll Surg. 2015 Jun;220(6):1087-95. doi: 10.1016/j.jamcollsurg.2015.02.013. Epub 2015 Feb 21.
In 2006, the Sendai Consensus Guidelines identified size >3.0 cm as the only independent predictor of malignancy in incidentally discovered pancreatic cysts. The 2012 updated guidelines increased emphasis on radiographic features over size. Earlier studies included patients with preoperatively diagnosed carcinoma or with a corresponding mass. In this report, we characterize the use of size and serum tumor markers in the initial evaluation of pancreatic cystic neoplasms without preoperatively diagnosed adenocarcinoma and correlate them with clinical and pathologic outcomes.
A retrospective cohort study was undertaken of 112 patients with a resected pancreatic cystic neoplasm. Patient demographics, cyst characteristics, preoperative serum tumor markers, morbidity, and mortality were captured. Statistical analysis included nonparametric tests of comparison, multivariate logistic regression, and receiver operating characteristic curve analyses.
One hundred and twelve pancreatic cystic neoplasms were resected; there was one perioperative death. Mucinous cysts were common (78%), followed by serous cysts (13%). In total, 17% of cysts harbored malignancy. On multivariate analysis, the risk of malignancy in cysts≥3 cm was more than 4 times that of smaller cysts (relative risk (RR)=4.32; 95% CI, 1.55-12.07). There was no significant difference in serum CEA, cancer antigen 19-9, or cyst-fluid CEA levels between the benign and malignant groups. At a median follow-up of 30 months, the incidence of diabetes was 15%.
Surgical resection of pancreatic cysts can be performed with low perioperative mortality and acceptable long-term morbidity. Use of cyst size as a rationale for resection of cystic lesion, as per the Sendai criteria, is justified.
2006年，《仙台共识指南》确定囊肿大小>3.0 cm是偶然发现的胰腺囊肿中唯一独立的恶性肿瘤预测指标。2012年更新的指南更加强调影像学特征而非囊肿大小。早期研究纳入了术前诊断为癌或有相应肿块的患者。在本报告中，我们描述了在术前未诊断为腺癌的胰腺囊性肿瘤初始评估中囊肿大小和血清肿瘤标志物的应用情况，并将它们与临床和病理结果相关联。
对112例接受胰腺囊性肿瘤切除术的患者进行了一项回顾性队列研究。记录了患者的人口统计学资料、囊肿特征、术前血清肿瘤标志物、发病率和死亡率。统计分析包括非参数比较检验、多因素逻辑回归分析和受试者工作特征曲线分析。
共切除112个胰腺囊性肿瘤；围手术期死亡1例。黏液性囊肿常见（78%），其次是浆液性囊肿（13%）。总共有17%的囊肿为恶性。多因素分析显示，囊肿≥3 cm的恶性风险是较小囊肿的4倍多（相对风险（RR）=4.32；95%置信区间，1.55 - 12.07）。良性和恶性组之间血清癌胚抗原（CEA）、癌抗原19 - 9或囊液CEA水平无显著差异。中位随访30个月时，糖尿病发病率为15%。
胰腺囊肿手术切除的围手术期死亡率低，长期发病率可接受。根据仙台标准，将囊肿大小作为切除囊性病变的依据是合理的。
