Clinical factors predictive of malignant and premalignant cystic neoplasms of the pancreas: A single institution experience

Natalie B. Jones, Ioannis Hatzaras, Nathaniel George, Peter Muscarella, E. Christopher Ellison, W. Scott Melvin, Mark Bloomston

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: As cystic neoplasms of the pancreas are discovered with advanced imaging techniques, pancreatic surgeons often strugglewith identifying who is at risk of having or developing pancreatic cancer. We sought to review our experience with the surgical management of cystic neoplasms of the pancreas to determine pre-operative clinical indicators of malignancy or premalignant (i.e. mucinous) lesions. Methods: Between 1996 and 2007, 114 consecutive patients with cystic neoplasms of the pancreas underwent a pancreatectomy. Invasive adenocarcinoma was identified in 35 whereas 79 had benign lesions. Mucinous lesions were considered premalignant and consisted of 29 intraductal papillary mucinous neoplasms (IPMN) and 17 mucinous cystic neoplasms (MCN). The remaining 33 benign lesions were serous microcystic adenomas. Descriptive statistics were calculated and multivariate logistic regression was performed. Receiver-operating characteristic (ROC) curves were constructed for continuous variables and the area under the curves compared. Likelihood ratios were calculated from the combinations of predictors. Results: Patients with pancreatic cancer arising from a cystic neoplasm were older than those with benign cysts. Mucinous lesions with or without associated cancer were more likely to be symptomatic and present with elevated serum carbohydrate antigen (CA)19-9 levels. Cancers more commonly presented in the head of the pancreas and were associated with longer hospitalizations after resection. Using multivariate logistic regression, size and elevated CA19-9 were predictors of malignancy whereas male gender and size were predictors of mucinous lesions with or without malignancy. Size, however, was not an accurate test to determine premalignant or malignant lesions using area under the ROC curve analysis whereas CA19-9 performed the best regardless of gender or lesion location. Conclusions: Based upon our single institution experience with resection of cystic neoplasms of the pancreas, we advocate an aggressive surgical approach to any patient with a cystic neoplasm of the pancreas and associated elevated CA19-9.

Original languageEnglish (US)
Pages (from-to)664-670
Number of pages7
JournalHPB
Volume11
Issue number8
DOIs
StatePublished - 2009
Externally publishedYes

Fingerprint

Pancreatic Neoplasms
Neoplasms
ROC Curve
Logistic Models
Pancreatectomy
Adenoma
Area Under Curve
Cysts
Pancreas
Adenocarcinoma
Hospitalization
Carbohydrates
Antigens
Serum

Keywords

  • Adenocarcinoma
  • CA19-9
  • Cystic neoplasms
  • IPMN
  • MCN
  • Pancreas

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Clinical factors predictive of malignant and premalignant cystic neoplasms of the pancreas : A single institution experience. / Jones, Natalie B.; Hatzaras, Ioannis; George, Nathaniel; Muscarella, Peter; Ellison, E. Christopher; Melvin, W. Scott; Bloomston, Mark.

In: HPB, Vol. 11, No. 8, 2009, p. 664-670.

Research output: Contribution to journalArticle

Jones, Natalie B. ; Hatzaras, Ioannis ; George, Nathaniel ; Muscarella, Peter ; Ellison, E. Christopher ; Melvin, W. Scott ; Bloomston, Mark. / Clinical factors predictive of malignant and premalignant cystic neoplasms of the pancreas : A single institution experience. In: HPB. 2009 ; Vol. 11, No. 8. pp. 664-670.
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abstract = "Background: As cystic neoplasms of the pancreas are discovered with advanced imaging techniques, pancreatic surgeons often strugglewith identifying who is at risk of having or developing pancreatic cancer. We sought to review our experience with the surgical management of cystic neoplasms of the pancreas to determine pre-operative clinical indicators of malignancy or premalignant (i.e. mucinous) lesions. Methods: Between 1996 and 2007, 114 consecutive patients with cystic neoplasms of the pancreas underwent a pancreatectomy. Invasive adenocarcinoma was identified in 35 whereas 79 had benign lesions. Mucinous lesions were considered premalignant and consisted of 29 intraductal papillary mucinous neoplasms (IPMN) and 17 mucinous cystic neoplasms (MCN). The remaining 33 benign lesions were serous microcystic adenomas. Descriptive statistics were calculated and multivariate logistic regression was performed. Receiver-operating characteristic (ROC) curves were constructed for continuous variables and the area under the curves compared. Likelihood ratios were calculated from the combinations of predictors. Results: Patients with pancreatic cancer arising from a cystic neoplasm were older than those with benign cysts. Mucinous lesions with or without associated cancer were more likely to be symptomatic and present with elevated serum carbohydrate antigen (CA)19-9 levels. Cancers more commonly presented in the head of the pancreas and were associated with longer hospitalizations after resection. Using multivariate logistic regression, size and elevated CA19-9 were predictors of malignancy whereas male gender and size were predictors of mucinous lesions with or without malignancy. Size, however, was not an accurate test to determine premalignant or malignant lesions using area under the ROC curve analysis whereas CA19-9 performed the best regardless of gender or lesion location. Conclusions: Based upon our single institution experience with resection of cystic neoplasms of the pancreas, we advocate an aggressive surgical approach to any patient with a cystic neoplasm of the pancreas and associated elevated CA19-9.",
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T1 - Clinical factors predictive of malignant and premalignant cystic neoplasms of the pancreas

T2 - A single institution experience

AU - Jones, Natalie B.

AU - Hatzaras, Ioannis

AU - George, Nathaniel

AU - Muscarella, Peter

AU - Ellison, E. Christopher

AU - Melvin, W. Scott

AU - Bloomston, Mark

PY - 2009

Y1 - 2009

N2 - Background: As cystic neoplasms of the pancreas are discovered with advanced imaging techniques, pancreatic surgeons often strugglewith identifying who is at risk of having or developing pancreatic cancer. We sought to review our experience with the surgical management of cystic neoplasms of the pancreas to determine pre-operative clinical indicators of malignancy or premalignant (i.e. mucinous) lesions. Methods: Between 1996 and 2007, 114 consecutive patients with cystic neoplasms of the pancreas underwent a pancreatectomy. Invasive adenocarcinoma was identified in 35 whereas 79 had benign lesions. Mucinous lesions were considered premalignant and consisted of 29 intraductal papillary mucinous neoplasms (IPMN) and 17 mucinous cystic neoplasms (MCN). The remaining 33 benign lesions were serous microcystic adenomas. Descriptive statistics were calculated and multivariate logistic regression was performed. Receiver-operating characteristic (ROC) curves were constructed for continuous variables and the area under the curves compared. Likelihood ratios were calculated from the combinations of predictors. Results: Patients with pancreatic cancer arising from a cystic neoplasm were older than those with benign cysts. Mucinous lesions with or without associated cancer were more likely to be symptomatic and present with elevated serum carbohydrate antigen (CA)19-9 levels. Cancers more commonly presented in the head of the pancreas and were associated with longer hospitalizations after resection. Using multivariate logistic regression, size and elevated CA19-9 were predictors of malignancy whereas male gender and size were predictors of mucinous lesions with or without malignancy. Size, however, was not an accurate test to determine premalignant or malignant lesions using area under the ROC curve analysis whereas CA19-9 performed the best regardless of gender or lesion location. Conclusions: Based upon our single institution experience with resection of cystic neoplasms of the pancreas, we advocate an aggressive surgical approach to any patient with a cystic neoplasm of the pancreas and associated elevated CA19-9.

AB - Background: As cystic neoplasms of the pancreas are discovered with advanced imaging techniques, pancreatic surgeons often strugglewith identifying who is at risk of having or developing pancreatic cancer. We sought to review our experience with the surgical management of cystic neoplasms of the pancreas to determine pre-operative clinical indicators of malignancy or premalignant (i.e. mucinous) lesions. Methods: Between 1996 and 2007, 114 consecutive patients with cystic neoplasms of the pancreas underwent a pancreatectomy. Invasive adenocarcinoma was identified in 35 whereas 79 had benign lesions. Mucinous lesions were considered premalignant and consisted of 29 intraductal papillary mucinous neoplasms (IPMN) and 17 mucinous cystic neoplasms (MCN). The remaining 33 benign lesions were serous microcystic adenomas. Descriptive statistics were calculated and multivariate logistic regression was performed. Receiver-operating characteristic (ROC) curves were constructed for continuous variables and the area under the curves compared. Likelihood ratios were calculated from the combinations of predictors. Results: Patients with pancreatic cancer arising from a cystic neoplasm were older than those with benign cysts. Mucinous lesions with or without associated cancer were more likely to be symptomatic and present with elevated serum carbohydrate antigen (CA)19-9 levels. Cancers more commonly presented in the head of the pancreas and were associated with longer hospitalizations after resection. Using multivariate logistic regression, size and elevated CA19-9 were predictors of malignancy whereas male gender and size were predictors of mucinous lesions with or without malignancy. Size, however, was not an accurate test to determine premalignant or malignant lesions using area under the ROC curve analysis whereas CA19-9 performed the best regardless of gender or lesion location. Conclusions: Based upon our single institution experience with resection of cystic neoplasms of the pancreas, we advocate an aggressive surgical approach to any patient with a cystic neoplasm of the pancreas and associated elevated CA19-9.

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KW - IPMN

KW - MCN

KW - Pancreas

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