Malignant Factors Analysis And Surgical Treatment Of Pancreatic Cystic Neoplasms

Objective:This paper aims to analysize the malignant factors of pancreatic cystic neoplasms(PCNs),and make differential diagnosis of benign and malignant pancreatic cystic neoplasms,and guide the surgical treatment.Methods:The clinical data of 80 patients with PCNs in our hospital(shanxi provincial people,s hospital)from February 2005 to January 2015 were retrospectively analyzed.The patients’ age,gender,amylase of cyst fluid,blood amylase,blood CA199 of preoperative,blood glucose,tumor location,tumor size,having nodules or solid components,CEA of cyst fluid,regional lymph node enlargement,clinical symptoms(such as abdominal pain)and other indicators were collected. The patients were grouped according to the pathological diagnosis,and case-control study was done on 80 patients with PCNs.First of all, the relationship between various factors and tumor characterization is analyzed by univariate analysis,then the possible correlation factors were analyzed by multivariate logistic regression analysis.Results:This group of 80 cases of patients with SCN,28 cases were benign lesions,pathological examination without atypia,accounted for 35%;32 cases of MCN,accounted for 40%,including 11 cases of malignant MCN;12 cases of IPMN,accounted for 15%, including 4 cases of malignant IPMN;8 cases of SPN, accounting for 10%, which malignant SPN had 2 cases.24 cases were male(30%),56 cases offemale(70%),the differences between the two groups had no statistically significant.The average age of patients was 50.18±11.53 years old,the average age of malignant tumor patients was 59.24±11.31 years old,the average age of patients with benign tumor group was 47.7±10.38 years old,the differences between the two groups had statistically significant(P<0.001). Imaging findings of CT performance showed benign tumor group average diameter was 5.7±2.32 cm and average diameter of malignant tumor group was 9.5±2.48 cm,the differences between the two groups had statistically significant(P<0.001).The number of benign with cystic wall nodules or the solid component was 17 cases,malignant group was 11 cases,the differences between the two groups had statistically significant(P=0.004).Preoperative detection of serum tumor markers CA199, there were 58 cases which CA199 value were less than 37 U/ml in benign group,but the malignant group have 8 cases,the differences between the two groups had statistically significant(P<0.001).Intraoperative find enlargement of the regional lymph nodes,benign group(12 cases),malignant group(10cases), the differences between the two groups had statistically significant(P=0.002).Detection of cystic fluid CEA value, there were 49 cases which CEA value were less than 192 ng/ml in benign group,but the malignant group have 5 cases,the differences between the two groups had statistically significant(P<0.001).Multivariate logistic regression analysis shows that older age(P=0.012),larger diameter of tumor(P=0.004),enlargement of the regional lymph nodes(P=0.035) and high cystic fluid CEA value(P=0.006)are the independent risk factors of malignant transformation of PCNs.Conclusion:Elder age,lager tumor, enlargement of the regional lymph nodes and high cystic fluid CEA value are the independent risk factors for malignant transformation of PCNs.The differential diagnosis before operation is very important,avoiding misdiagnosis,mistreatment. This study make the comprehensive diagnosis from the preoperative clinical symptoms,main signs,imaging findings,laboratory indicators and make up the difficulties in the performance of a single imaging and laboratory diagnosis,as possible to improve the rate of diagnosis of PCNs.Even though most tumors are benign,tumors should be radically resected,especially those with signs of malignancy.