切除的主导管和混合型导管内乳头状黏液瘤发生胰腺癌和高级别发育不良的风险：发病率荟萃分析。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-03-05 DOI:10.1016/j.ejso.2025.109742

Omar Mahmud , Asad Saulat Fatimi , Mahip Grewal , Charles DiMaggio , D. Brock Hewitt , Ammar A. Javed , Christopher L. Wolfgang , Greg D. Sacks

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引用次数: 0

摘要

背景：目前的指南建议根据特定的风险标准切除主管（MD）和混合型（MT）导管内乳头状粘液瘤（IPMN），以预防或治疗特定患者的胰腺癌。这种模式遵循在已发表的外科系列中观察到的高恶性肿瘤率。本系统综述和荟萃分析的目的是提供胰腺切除的MD-和MT-IPMNs中浸润性癌（IC）和高级别不典型增生（HGD）的可靠汇总率。方法：系统检索PubMed、Embase、Scopus、Web of Science、Cochrane CENTRAL等数据库。研究报告了在MD-或MT-IPMNs中，通过手术标本的组织病理学诊断为IC或HGD的发生率。采用随机效应模型计算95%置信区间（95% CI）的合并患病率。采用Galbraith图评价异质性。使用美国国立卫生研究院质量评估工具评估偏倚风险。结果：基于51项研究，59% （95% CI: 54%, 64%）切除的MD-和MT-IPMN有IC或HGD， IC占39% （95% CI: 33%, 44%）的病变，HGD占20% （95% CI: 16%, 25%）。大多数研究被认为是高质量的，Galbraith图显示出高度的一致性。结论：这些结果证实了切除的MD/MT-IPMNs中IC和HGD的发生率。然而，相当比例的患者为良性病变，需要未来的研究来制定精确的诊断方法，以区分患者是否患有高风险或癌性疾病。

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Risk of pancreatic cancer and high-grade dysplasia in resected main-duct and mixed-type intraductal papillary mucinous neoplasms: A prevalence meta-analysis

Background

Current guidelines recommend the resection of main duct- (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMN) based on specific risk criteria to prevent or treat pancreatic cancer in selected patients. This paradigm follows high rates of malignancy observed in published surgical series. The aim of this systematic review and meta-analysis was to provide robust, pooled rates of invasive carcinoma (IC) and high-grade dysplasia (HGD) in resected MD- and MT-IPMNs of the pancreas.

Methods

The PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL databases were systematically searched. Studies that reported rates of IC or HGD, diagnosed by histopathology of surgical specimens, in MD- or MT-IPMNs were included. Pooled prevalence with 95 % confidence interval (95 % CI) was calculated using a random effects model. Galbraith plots were used to evaluate heterogeneity. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool.

Results

Based on 51 studies, 59 % (95 % CI: 54 %, 64 %) of resected MD- and MT-IPMN had IC or HGD, with IC in up to 39 % (95 % CI: 33 %, 44 %) of lesions and HGD in 20 % (95 % CI: 16 %, 25 %). Most studies were deemed to be of good quality and Galbraith plots demonstrated high concordance.

Conclusions

These results confirm the rates of IC and HGD in resected MD/MT-IPMNs. However, a significant proportion of patients have benign lesions, and future research is needed to develop precise diagnostics to distinguish between patients with and without high-risk or cancerous disease.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.