背景:胰腺粘液性囊性肿瘤(MCN)表达雌激素和孕激素受体。一些病例报告描述了妊娠期间MCN的大小增加。这项研究的目的是评估妊娠是否是MCN恶性变性的危险因素。
方法:纳入了2011年至2021年期间接受胰腺切除MCN的所有女性患者。在妊娠12个月内切除或诊断的MCN被定义为孕周。将具有高级别发育不良或侵入性成分的MCN分类为高级别(HG)组。主要结局定义为妊娠暴露和孕周MCN与HG-MCN发展之间的相关性。
结果:该研究包括176名患者,25(14%)组成HG组,和151(86%)组成低等级(LG)组。LG和HG组的全身避孕药使用分布相似(26%vs.16%,p=0.262),和孕周MCN(7%对16%,p=0.108)。在单因素分析中,囊肿大小≥10cm(OR5.3,p<0.001)与HG变性有关。围妊娠MCN与囊肿大小呈正相关(R=0.18,p=0.020)。在14例孕周MCN患者的亚组中,29%的患者患有HG-MCN,71%的患者在妊娠期间出现囊肿生长,平均生长为55.1±18mm。
结论:孕周MCN与囊肿直径增加有关,在妊娠期间受MCN影响的患者亚组中,观察到高增长率。有MCN和妊娠愿望的患者应接受多学科咨询。
BACKGROUND: Mucinous cystic neoplasms (MCN) of the pancreas express estrogen and progesterone receptors. Several
case reports describe MCN increasing in size during gestation. The aim of this study is to assess if pregnancy is a risk factor for malignant degeneration of MCN.
METHODS: All female patients who underwent pancreatic resection of a MCN between 2011 and 2021 were included. MCN resected or diagnosed within 12 months of gestation were defined perigestational. MCN with high grade dysplasia or an invasive component were classified in the high grade (HG) group. The primary outcome was defined as the correlation between exposure to gestation and peri-gestational MCN to development of HG-MCN.
RESULTS: The study includes 176 patients, 25 (14 %) forming the HG group, and 151 (86 %) forming the low grade (LG) group. LG and HG groups had a similar distribution of systemic contraceptives use (26 % vs. 16 %, p = 0.262), and perigestational MCN (7 % vs 16 %, p = 0.108). At univariate analysis cyst size ≥10 cm (OR 5.3, p < 0.001) was associated to HG degeneration. Peri gestational MCN positively correlated with cyst size (R = 0.18, p = 0.020). In the subgroup of 14 perigestational MCN patients 29 % had HG-MCN and 71 % experienced cyst growth during gestation with an average growth of 55.1 ± 18 mm.
CONCLUSIONS: Perigestational MCN are associated to increased cyst diameter, and in the subset of patients affected by MCN during gestation a high rate of growth was observed. Patients with a MCN and pregnancy desire should undergo multidisciplinary counselling.