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Association of Preoperative Risk Factors With Malignancy in Pancreatic Mucinous Cystic Neoplasms: A Multicenter Study
Lauren M Postlewait1, Cecilia G Ethun1, Mia R McInnis1
1Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia.
JAMA Surgery
|October 21, 2016
Summary
Malignancy in pancreatic mucinous cystic neoplasms (MCNs) is linked to male sex, tumor location, size, solid components, and duct dilation. MCN-associated adenocarcinoma shows better survival than typical pancreatic cancer.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Pancreatic mucinous cystic neoplasms (MCNs) have malignant potential, necessitating resection.
- Limited data exists on preoperative risk factors for malignancy in MCNs.
Purpose of the Study:
- To identify preoperative risk factors for malignancy in resected MCNs.
- To evaluate outcomes of MCN-associated adenocarcinoma.
Main Methods:
- Retrospective analysis of 349 patients with MCNs undergoing pancreatic resection.
- Comparison of preoperative factors between malignant and non-malignant MCNs.
- Logistic regression models to determine associations with malignancy.
Main Results:
- Malignancy risk factors include male sex, pancreatic head/neck location, larger size, solid components/mural nodules, and duct dilation.
- Serum CA19-9 levels were significantly higher in malignant MCNs.
- MCN-associated adenocarcinoma had lower nodal metastasis rates and improved 3-year survival (59%) compared to typical pancreatic ductal adenocarcinoma.
Conclusions:
- Preoperative factors can predict malignancy in MCNs.
- MCN-associated adenocarcinoma may have a more favorable prognosis.
- Reassessment of resection guidelines for MCNs is warranted.
