Cyst Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Meta-Analysis
Cyst Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Meta-Analysis
复制标题
DOI：
10.1016/j.cgh.2013.02.010
复制
发表时间：
2013-08-01
影响因子：
12.6
通讯作者：
Wu, Bechien U.
中科院分区：
文献类型：
--
作者：
Anand, Neeraj;Sampath, Kartik;Wu, Bechien U.
背景与目的：胰腺导管内乳头状黏液性肿瘤（IPMN）的国际治疗指南建议对具有特殊特征的肿瘤进行手术切除。我们进行了荟萃分析，以评估与这些功能的IPMNs.METHODS：我们进行了一个全面的搜索MEDLINE从1996年1月1日至2011年11月11日，研究，其中包括任何功能的共识指南中提到的手术切除主导管和分支导管IPMNs的恶性风险。分析了41项研究的数据，包括以下特征：囊肿大小大于3 cm，存在壁结节，主胰管扩张，症状，主胰管与分支胰管IPMN。恶性IPMN定义为原位癌或组织学更晚期的IPMN。对每个风险因素进行单独的荟萃分析，以计算合并比值比（OR）。采用随机效应模型，基于研究人群间变异的假设。结果：与单个囊肿特征相关的恶性肿瘤风险如下：囊肿大小大于3 cm（OR，62.4; 95%置信区间[CI]，30.8-126.3），存在壁结节主胰管扩张（OR，7.27; 95% CI，3.0-17.4）和主胰管与分支胰管IPMN（OR，4.7; 95% CI，3.3-6.9）。有一个中等水平的异质性之间的研究（I-2范围，34-67）。结论：基于荟萃分析，囊肿的功能提出的国际指南切除IPMN与恶性肿瘤高度相关。然而，根据我们的研究结果，在考虑恶性风险时，并不是所有的囊肿特征都应该同等重视;囊肿大小大于3 cm与恶性IPMN的相关性最强。
BACKGROUND & AIMS: International guidelines for the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas recommend surgical resection of those with specific characteristics. We performed a meta-analysis to evaluate the risk of malignancy associated with each of these features of IPMNs.METHODS: We performed a comprehensive search of MEDLINE from January 1, 1996, to November 11, 2011, for studies that included any of the features mentioned in the consensus guidelines for surgical resection of main duct and branch duct IPMNs. Data were analyzed from 41 studies for the following features: cyst size greater than 3 cm, the presence of mural nodules, dilated main pancreatic duct, symptoms, and main duct vs branch duct IPMNs. Malignant IPMNs were defined as those with carcinoma in situ or more advanced histology. A separate meta-analysis was performed for each risk factor to calculate pooled odds ratios (ORs). A random-effects model was used, based on the assumption of variation among study populations.RESULTS: The risks of malignancy associated with individual cyst features were as follows: cyst size greater than 3 cm (OR, 62.4; 95% confidence interval [CI], 30.8-126.3), presence of a mural nodule (OR, 9.3; 95% CI, 5.3-16.1), dilatation of the main pancreatic duct (OR, 7.27; 95% CI, 3.0-17.4), and main vs branch duct IPMN (OR, 4.7; 95% CI, 3.3-6.9). There was a moderate level of heterogeneity among studies (I-2 range, 34-67).CONCLUSIONS: Based on a meta-analysis, cyst features proposed by the international guidelines for resection of IPMN were highly associated with malignancy. However, based on our findings, not all cyst features should be weighted equally when considering risk of malignancy; cyst size greater than 3 cm was associated most strongly with malignant IPMN.