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Cystic pancreatic tumors (CPT): Predictors of malignant behavior
Author(s) -
Javle Milind,
Shah Pankaj,
Yu Jihnhee,
Bhagat Vishal,
Litwin Alan,
Iyer Renuka,
Gibbs John
Publication year - 2007
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20648
Subject(s) - medicine , serous cystadenocarcinoma , malignancy , cystadenocarcinoma , adenocarcinoma , gastroenterology , serous fluid , pancreatic cancer , klatskin tumor , pancreas , hazard ratio , pathology , cancer , surgery , ovarian cancer , confidence interval , resection
Background and Objectives Due to widespread use of imaging studies, increasing cystic pancreatic tumor (CPT) cases are being detected. The diagnosis of malignancy in CPT cases requires pancreatectomy. Clinical and laboratory characteristics of CPT may predict underlying malignancy. Methods CPT cases treated between 1994 and 2004 at our institution were included. Pseudocysts were excluded. Serous cystadenoma (SCA), mucinous cystadenoma (MCA), intrapapillary mucinous tumor, cystic endocrine tumor, and lymphoepithelial cysts were classified as benign or pre‐malignant. Serous cystadenocarcinoma (SCACA), mucinous cystadenocarcinoma (MCACA), and adenocarcinoma (ACA) were classified as malignant. Results Thirty‐five patients had histological confirmation. Median age was 65 years. Male/female ratio was higher in malignant group ( P = 0.0284). Weight loss and abdominal mass were more prevalent in malignant group ( P = 0.042 and 0.028, respectively). Malignant lesions were larger, associated with local invasion (superior mesenteric artery (SMA), superior mesenteric vein (SMV), portal vein (PV) complex or celiac encasement) and CA 19‐9 elevation. On univariate analyses, local invasion ( P = 0.0029), negative surgical intervention ( P = 0.0010), presence of ACA ( P = 0.0044), or malignant CPT ( P = 0.0018) were associated with shorter survival. On a multivariate analysis, local invasion was associated with shorter survival [Hazard ratio (HR) = 4.322, P = 0.0218], while surgical intervention was associated with improved survival (HR = 0.179, P = 0.0124). Conclusion Male sex, abdominal mass, weight loss, larger tumor size, local invasion, and elevated CA 19‐9 were associated with malignant CPT. J. Surg. Oncol. 2007;95:221–228. © 2007 Wiley‐Liss, Inc.