Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2023; 29(20): 3119-3132
Published online May 28, 2023. doi: 10.3748/wjg.v29.i20.3119
Malignancy risk factors and prognostic variables of pancreatic mucinous cystic neoplasms in Chinese patients
Qing Xia, Fan Li, Rui Min, Shuai Sun, Yue-Xin Han, Zhen-Zhong Feng, Nan Li
Qing Xia, Rui Min, Nan Li, Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu 233004, Anhui Province, China
Fan Li, Shuai Sun, Department of Pathology, Bengbu Medical College, Bengbu 233030, Anhui Province, China
Yue-Xin Han, School of Clinical Medicine, Bengbu Medical College, Bengbu 233030, Anhui Province, China
Zhen-Zhong Feng, Nan Li, Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
Author contributions: Xia Q collected the clinical data and prepared the manuscript; Xia Q and Li F designed the study and supervised the statistical data; Xia Q and Min R designed the research and contributed to the analyses; Sun S, Han YX, and Feng ZZ provided clinical advice; Li N made the pathologic diagnosis and supervised the report; and all authors read and approved the final version.
Supported by the Natural Science Key Project in Universities of Anhui Province, No. KJ2021A0701; Natural Science Key Project of Bengbu Medical College, No. 2020byzd030; and Postgraduate Scientific Research Innovation Program of the Bengbu Medical College, No. Byycx22016.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Bengbu Medical College (approval No. 2021085).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nan Li, Doctor, MD, PhD, Chief Doctor, Professor, Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu 233004, Anhui Province, China. linanangel100@sina.com
Received: March 3, 2023
Peer-review started: March 3, 2023
First decision: April 12, 2023
Revised: April 21, 2023
Accepted: May 4, 2023
Article in press: May 4, 2023
Published online: May 28, 2023
Abstract
BACKGROUND

Pancreatic mucinous cystic neoplasms (MCNs) represent one of the precursor lesions of pancreatic ductal adenocarcinoma, and their detection has been facilitated by advances in preoperative imaging. Due primarily to the rarity of MCNs, however, there is limited knowledge regarding the prognostic variables and high-risk factors for malignant transformation. A more comprehensive and nuanced approach is necessary to fill this gap and provide a basis for improved treatment decisions and patient outcomes.

AIM

To investigate the high-risk factors associated with malignant MCNs and to explore the prognostic factors of MCN with associated invasive carcinoma (MCN-AIC).

METHODS

All cases of resected MCNs from a single high-volume institution between January 2012 and January 2022 were retrospectively reviewed. Only cases with ovarian-type stroma verified by progesterone receptor staining were included. Preoperative features, histological findings and postoperative course were documented. Multivariate logistic regression was employed to investigate variables related to malignancy. Survival analysis was performed using the Kaplan-Meier curve, and the prognostic factors were assessed to evaluate the postoperative course of patients with MCN-AIC.

RESULTS

Among the 48 patients, 36 had benign MCNs, and 12 had malignant MCNs (1 high-grade atypical hyperplasia and 11 MCN-AIC). Age, tumour size, presence of solid components or mural nodules and pancreatic duct dilatation were identified as independent risk factors associated with malignancy. The follow-up period ranged from 12 mo to 120 mo, with a median overall survival of 58.2 mo. Only three patients with MCN-AIC died, and the 5-year survival rate was 70.1%. All 11 cases of MCN-AIC were stage I, and extracapsular invasion was identified as a prognostic factor for poorer outcomes.

CONCLUSION

The risk factors independently associated with malignant transformation of MCNs included age, tumour size, presence of solid components or mural nodules, and pancreatic duct dilatation. Our study also revealed that encapsulated invasion was a favourable prognostic factor in MCN-AIC patients.

Keywords: Mucinous cystic neoplasms, Pancreatic adenocarcinoma, Invasive carcinoma, Risk of malignancy, Prognostic factor, Retrospective study

Core Tip: Pancreatic mucinous cystic neoplasms (MCNs) are a rare tumour with a low incidence and one of the precursor lesions of pancreatic ductal adenocarcinoma. The detection of MCN has been increasing by advances in imaging technology. MCNs associated risk factors, clinicopathological manifestations, and prognosis must be explored to improve our understanding of this rare tumour type and optimize clinical treatment.