Preoperative Risk Factors For Malignancy In Pancreatic MCNs Identified

Parameters predicting the development of adenocarcinoma or high-grade dysplasia from pancreatic mucinous cystic neoplasms have been determined

  • Date: 20 Oct 2016
  • Author: By Shreeya Nanda, Senior medwireNews Reporter
  • Topic: Pancreatic Cancer

medwireNews: A US research team has pinpointed the risk factors associated with malignant transformation of pancreatic mucinous cystic neoplasms (MCNs).

The risk of developing adenocarcinoma or high-grade dysplasia was independently and significantly elevated 3.72-fold for male patients, report Shishir Maithel, from the Winship Cancer Institute in Atlanta, Georgia, and colleagues.

Furthermore, certain MCN characteristics also significantly predicted an increased malignancy risk, such as presence of a solid component or mural nodule, ductal dilation and a pancreatic head and neck location, with odds ratios (ORs) of 4.54, 4.17 and 3.93, respectively.

Larger MCNs were also significantly associated with a raised risk of malignant transformation, with an OR of 1.17, but the study authors were unable to determine a cutoff as malignancies developed even in MCNs smaller than 3 cm. They point out that over half (60%) of the 10 individuals with small MCNs that underwent malignant transformation had at least two additional high-risk features.

Other factors, including serum CA19-9 levels or the presence of radiographical septations, did not predict the development of malignancy.

The study, reported in JAMA Surgery, included 349 patients (88.8% women) who underwent resection of a pancreatic MCN between 2000 and 2014 at one of the eight member institutions of the Central Pancreas Consortium. Adenocarcinoma or high-grade dysplasia was detected in 14.9% of participants.

Shishir Maithel et al explain that current consensus guidelines recommend resection for all patients with MCNs deemed surgical candidates. However, in light of their findings, they say that “perhaps not all patients with MCNs need to undergo resection but could be kept under radiographic surveillance.”

But Markus Büchler and fellow editorialists, from Heidelberg University Hospital in Germany, believe that the results reinforce rather than challenge the current guidelines.

“Although the risk features demonstrated by the this series may be helpful, there is still too little knowledge about the natural course of MCNs to justify safe observation protocols, and the overall malignancy rate of 15% must make us question any conservative management approach”, they write.

Given the limitations of the study, such as the lack of preoperative surveillance data, the editorial authors say that “a surveillance strategy for MCNs cannot be recommended.”

“Because the prognosis of even malignant MCNs is definitely better than that of sporadic pancreatic ductal adenocarcinoma (ie, owing to a lower incidence of lymph node involvement), the indication for surgery for all patients who are fit for a resection needs to be emphasized”, conclude Markus Büchler and co-authors.

References

Postlewait LM, Ethun CG, McInnis MR, et al. Association of preoperative risk factors with malignancy in pancreatic mucinous cystic neoplasms. A multicenter study. JAMA Surg; Advance online publication 19 October 2016. doi:10.1001/jamasurg.2016.3598

Hackert T, Michalski CW, Büchler MW. Mucinous cystic neoplasms of the pancreas. A surgical disease. JAMA Surg; Advance online publication 19 October 2016. doi:10.1001/jamasurg.2016.3596

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