切除的胰腺黏液性囊性肿瘤的恶性肿瘤风险。

Risk of malignancy in resected pancreatic mucinous cystic neoplasms.

机构信息

Institute for Liver and Digestive Health, University College London, London.

Department of Surgery, Southampton University Hospital, Southampton, UK.

出版信息

Br J Surg. 2018 Mar;105(4):439-446. doi: 10.1002/bjs.10787.

DOI:10.1002/bjs.10787

PMID:29488646

Abstract

BACKGROUND

Pancreatic mucinous cystic neoplasms (MCNs) are rare mucin-producing cystic tumours defined by the presence of ovarian-type stroma. MCNs have a malignant potential and thus surgery is frequently performed. The aim of this cohort study was to define better the criteria for surgical resection in patients with MCN.

METHODS

This multicentre retrospective study included all resected MCNs between 2003 and 2015 in participating centres. Lesions without ovarian-type stroma were excluded. Patient characteristics, preoperative findings, histopathology findings and follow-up data were recorded.

RESULTS

The study included 211 patients; their median age was 53 (range 18-82) years, and 202 (95·7 per cent) were women. Median preoperative tumour size was 55 (range 12-230) mm. Thirty-four of the 211 (16·1 per cent) were malignant, and high-grade dysplasia (HGD) was found in a further 13 (6·2 per cent). One-third of MCNs in men were associated with invasive cancer, compared with 15·3 per cent in women. Five cases of malignant transformation occurred in MCNs smaller than 4 cm. All cases of malignancy or HGD were associated with symptoms or features of concern on preoperative cross-sectional imaging. In multivariable analysis, raised carbohydrate antigen 19-9 (odds ratio (OR) 10·54, 95 per cent c.i. 2·85 to 218·23; P < 0·001), tumour size (OR 4·23, 3·02 to 11·03; P = 0·001), mural nodules (OR 3·55, 1·31 to 20·55; P = 0·002) and weight loss (OR 3·40, 2·34 to 12·34; P = 0·034) were independent factors predictive of malignant transformation.

CONCLUSIONS

Small indeterminate MCNs with no symptoms or features of concern may safely be observed as they have a low risk of malignant transformation.

摘要

背景

胰腺黏液性囊性肿瘤（MCN）是一种罕见的黏液性囊性肿瘤，其特征为存在卵巢型基质。MCN 具有恶性潜能，因此常需手术治疗。本队列研究旨在确定 MCN 患者手术切除的标准。

方法

该多中心回顾性研究纳入了 2003 年至 2015 年间参与中心切除的所有 MCN 患者。排除无卵巢型基质的病变。记录患者特征、术前检查、组织病理学检查和随访数据。

结果

研究共纳入 211 例患者；中位年龄为 53 岁（范围 18-82 岁），202 例（95.7%）为女性。中位术前肿瘤大小为 55 毫米（范围 12-230 毫米）。211 例中有 34 例（16.1%）为恶性，13 例（6.2%）为高级别异型增生（HGD）。男性 MCN 中有 1/3 与浸润性癌相关，而女性为 15.3%。5 例恶性转化发生在小于 4cm 的 MCN 中。所有恶性或 HGD 病例均与术前横断面成像的症状或特征有关。多变量分析显示，糖链抗原 19-9 升高（比值比（OR）10.54，95%置信区间（CI）2.85 至 218.23；P<0.001）、肿瘤大小（OR 4.23，3.02 至 11.03；P=0.001）、壁结节（OR 3.55，1.31 至 20.55；P=0.002）和体重减轻（OR 3.40，2.34 至 12.34；P=0.034）是恶性转化的独立预测因素。