Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, USA; The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona, Verona, Italy.
The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona, Verona, Italy.
HPB (Oxford). 2023 Jul;25(7):747-757. doi: 10.1016/j.hpb.2023.03.001. Epub 2023 Mar 9.
Mucinous Cystic Neoplasms (MCN) of the pancreas are premalignant cysts for which current guidelines support pancreatic resection. The primary aim of this systematic review and meta-analysis is to define the pooled rate of malignancy for MCN.
A systematic review of eligible studies published between 2000 and 2021 was performed on PubMed and Embase. Primary outcome was rate of malignancy. Data regarding high-risk features, including cyst size and mural nodules, were collected and analyzed.
A total of 40 studies and 3292 patients with resected MCN were included in the final analysis. The pooled rate of malignancy was 16.1% (95%CI 13.1-19.0). The rate of malignant MCN in studies published before 2012 was significantly higher than that of studies published after recent guidelines were published (21.0% vs 14.9%, p < 0.001). Malignant MCN were larger than benign (mean difference 25.9 mm 95%CI 14.50-37.43, p < 0.001) with a direct correlation between size and presence of malignant MCN (R2 = 0.28, p = 0.020). A SROC identified a threshold of 65 mm to be associated with the diagnosis of malignant MCN. Presence of mural nodules was associated with the diagnosis of a malignant MCN (OR = 4.34, 95%CI 3.00-6.29, p < 0.001).
Whereas guidelines recommend resection of all MCN, the rate of malignancy in resected MCN is 16%, implying that surveillance has a role in most cases, and that surgical selection criteria are warranted. Size and presence of mural nodules are significantly associated with an increased risk of malignant degeneration, small MCN and without mural nodules can be considered for surveillance.
胰腺黏液性囊性肿瘤（MCN）是一种潜在恶性的囊肿，目前的指南支持胰腺切除术。本系统评价和荟萃分析的主要目的是定义 MCN 的恶性肿瘤发生率。
对 2000 年至 2021 年间发表的符合条件的研究进行了 PubMed 和 Embase 的系统检索。主要结局是恶性肿瘤的发生率。收集并分析了包括囊肿大小和壁结节等高危特征的数据。
共纳入 40 项研究和 3292 例接受 MCN 切除术的患者。恶性肿瘤的总发生率为 16.1%（95%CI 13.1-19.0）。2012 年前发表的研究中恶性 MCN 的发生率明显高于近期指南发布后发表的研究（21.0% vs 14.9%，p<0.001）。恶性 MCN 比良性 MCN 更大（平均差值 25.9mm 95%CI 14.50-37.43，p<0.001），且大小与恶性 MCN 的存在之间存在直接相关性（R2=0.28，p=0.020）。SROC 确定 65mm 为诊断恶性 MCN 的阈值。壁结节的存在与恶性 MCN 的诊断相关（OR=4.34，95%CI 3.00-6.29，p<0.001）。
尽管指南建议切除所有 MCN，但切除的 MCN 的恶性肿瘤发生率为 16%，这意味着在大多数情况下监测具有作用，并且需要手术选择标准。大小和壁结节的存在与恶性变性的风险增加显著相关，小的 MCN 且无壁结节可考虑进行监测。
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