膵粘液嚢胞性腫瘍（MCN）は全例，切除の適応か？：3つのガイドラインと多数例の後ろ向き観察研究よりみた検討
MCNは全例外科的に切除すべきか？との問題について，3つのガイドライン，大きな後ろ向き観察研究などのエビデンスをもとに，概説した．IAPガイドラインとヨーロッパ専門家コンセンサスはIPMNとMCNを別個のものとして扱っているが，AGAガイドラインは膵嚢胞性腫瘍でまとめて，臨床的取扱いはIPMN，MCなどを区別していない．IAPではMCNは全例切除すべきとの立場だが，その他の2つのガイドラインはMCNの症状の有無，腫瘍マーカー，嚢胞径，壁在結節，主膵管拡張などの悪性（浸潤性）予測因子により手術適応を考えようとの立場である．多数例の（多施設）後ろ向き観察研究でもMCNは全例手術すべきとの意見もある...
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| Published in | 膵臓 Vol. 32; no. 5; pp. 795 - 805 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本膵臓学会
2017
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0913-0071 1881-2805 |
| DOI | 10.2958/suizo.32.795 |
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| Abstract | MCNは全例外科的に切除すべきか？との問題について，3つのガイドライン，大きな後ろ向き観察研究などのエビデンスをもとに，概説した．IAPガイドラインとヨーロッパ専門家コンセンサスはIPMNとMCNを別個のものとして扱っているが，AGAガイドラインは膵嚢胞性腫瘍でまとめて，臨床的取扱いはIPMN，MCなどを区別していない．IAPではMCNは全例切除すべきとの立場だが，その他の2つのガイドラインはMCNの症状の有無，腫瘍マーカー，嚢胞径，壁在結節，主膵管拡張などの悪性（浸潤性）予測因子により手術適応を考えようとの立場である．多数例の（多施設）後ろ向き観察研究でもMCNは全例手術すべきとの意見もあるが，最近の論文では悪性予測因子で手術適応を考えようとするものが多い．MCNの手術適応に関して，ガイドライン，多数例の後向き観察研究のエビデンスを検討し，概説した． |
|---|---|
| AbstractList | MCNは全例外科的に切除すべきか？との問題について，3つのガイドライン，大きな後ろ向き観察研究などのエビデンスをもとに，概説した．IAPガイドラインとヨーロッパ専門家コンセンサスはIPMNとMCNを別個のものとして扱っているが，AGAガイドラインは膵嚢胞性腫瘍でまとめて，臨床的取扱いはIPMN，MCなどを区別していない．IAPではMCNは全例切除すべきとの立場だが，その他の2つのガイドラインはMCNの症状の有無，腫瘍マーカー，嚢胞径，壁在結節，主膵管拡張などの悪性（浸潤性）予測因子により手術適応を考えようとの立場である．多数例の（多施設）後ろ向き観察研究でもMCNは全例手術すべきとの意見もあるが，最近の論文では悪性予測因子で手術適応を考えようとするものが多い．MCNの手術適応に関して，ガイドライン，多数例の後向き観察研究のエビデンスを検討し，概説した． |
| Author | 山口, 幸二 |
| Author_xml | – sequence: 1 fullname: 山口, 幸二 organization: 国家公務員共済連合会浜の町病院福岡合同庁舎診療所 |
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| References | 13) Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12: 183-97. 10) Goh BK, Tan YM, Chung YF, et al. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg 2006; 30: 2236-45. 2) Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 1978; 69: 573-80. 11) Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann Surg 1999; 230: 152-61. 14) Lennon AM, Ahuja N, Wolfgang CL. AGA Guidelines for the Management of Pancreatic Cysts. Gastroenterology 2015; 149: 825. 7) Hamilton S, Aaltonen L. World Health Organization Classification of Tumours. Pathology & Genetics of Tumours of the Digestive System. Lyon: IARC Press, 2000. 20) Testini M, Gurrado A, Lissidini G, Venezia P, Greco L, Piccinni G. Management of mucinous cystic neoplasms of the pancreas. World J Gastroenterol 2010; 16: 5682-92. 17) American Gastroenterological Association. Management of asymptomatic neoplastic pancreatic cysts: clinical decision support tool. Gastroenterology 2015; 148: 823. 23) Park JW, Jang JY, Kang MJ, Kwon W, Chang YR, Kim SW. Mucinous cystic neoplasm of the pancreas: is surgical resection recommended for all surgically fit patients? Pancreatology 2014; 14: 131-6. 29) Postlewait LM, Ethun CG, McInnis MR, et al. Association of Preoperative Risk Factors With Malignancy in Pancreatic Mucinous Cystic Neoplasms: A Multicenter Study. JAMA Surg 2017; 152: 19-25. 8) Yamao K, Yanagisawa A, Takahashi K, et al. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. Pancreas 2011; 40: 67-71. 4) 大橋計彦, 村上義央, 丸山雅一. 粘液産生膵癌の4例: 特殊な十二指腸乳頭所見を中心にして. Prog Dig Endosc 1982; 20: 348-51. 27) Scourtas A, Dudley JC, Brugge WR, Kadayifci A, Mino-Kenudson M, Pitman MB. Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms. Cancer 2017; 125: 169-77. 26) Jang KT, Park SM, Basturk O, et al. Clinicopathologic characteristics of 29 invasive carcinomas arising in 178 pancreatic mucinous cystic neoplasms with ovarian-type stroma: implications for management and prognosis. Am J Surg Pathol 2015; 39: 179-87. 12) Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg 2000; 231: 205-12. 19) Wilentz RE, Albores-Saavedra J, Zahurak M, et al. Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol 1999; 23: 1320-7. 24) Singhi AD, Zeh HJ, Brand RE, et al. American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data. Gastrointest Endosc 2016; 83: 1107-17.e1102. 22) Nguyen D, Dawson DW, Hines OJ, Reber HA, Donahue TR. Mucinous cystic neoplasms of the pancreas: are we overestimating malignant potential? Am Surg 2014; 80: 915-9. 6) Solcia E, Capella C, Kloeppel G. Tumors of the pancreas. In: Rosai J, ed. Atlas of Tumor Pathology. Fascicle 20, 3rd Series. Washington DC: Armed Forces Institute of Pathology, 1997. 1) Jordan GL Jr. Pancreatic cysts. In: Howard JM, Jordan GL Jr, eds. Surgical diseases of the pancreas. Philadelphia: J.B. Lippincott, 1960: 283-320. 18) Ducreux M, Cuhna AS, Caramella C, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl 5): v56-68. 21) Le Baleur Y, Couvelard A, Vullierme MP, et al. Mucinous cystic neoplasms of the pancreas: definition of preoperative imaging criteria for high-risk lesions. Pancreatology 2011; 11: 495-9. 25) Xourafas D, Tavakkoli A, Clancy TE, Ashley SW. Noninvasive intraductal papillary mucinous neoplasms and mucinous cystic neoplasms: recurrence rates and postoperative imaging follow-up. Surgery 2015; 157: 473-83. 16) Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45: 703-11. 28) Nilsson LN, Keane MG, Shamali A, et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature. Pancreatology 2016; 16: 1028-36. 3) Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol 1978; 69: 289-98. 9) Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol 2004; 2: 1026-31. 5) Klöppel G, Solcia E, Longnecker DS, Capella C, Sobin LH; World Health Orginization. International histological classification of tumours. Histological typing of tumours of exocrine pancreas. Second ed. Berlin: Springer-Verlag, 1996. 15) Vege SS, Ziring B, Jain R, Moayyedi P. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819-22; quize812-3. |
| References_xml | – reference: 8) Yamao K, Yanagisawa A, Takahashi K, et al. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. Pancreas 2011; 40: 67-71. – reference: 25) Xourafas D, Tavakkoli A, Clancy TE, Ashley SW. Noninvasive intraductal papillary mucinous neoplasms and mucinous cystic neoplasms: recurrence rates and postoperative imaging follow-up. Surgery 2015; 157: 473-83. – reference: 24) Singhi AD, Zeh HJ, Brand RE, et al. American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data. Gastrointest Endosc 2016; 83: 1107-17.e1102. – reference: 3) Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol 1978; 69: 289-98. – reference: 9) Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol 2004; 2: 1026-31. – reference: 1) Jordan GL Jr. Pancreatic cysts. In: Howard JM, Jordan GL Jr, eds. Surgical diseases of the pancreas. Philadelphia: J.B. Lippincott, 1960: 283-320. – reference: 7) Hamilton S, Aaltonen L. World Health Organization Classification of Tumours. Pathology & Genetics of Tumours of the Digestive System. Lyon: IARC Press, 2000. – reference: 21) Le Baleur Y, Couvelard A, Vullierme MP, et al. Mucinous cystic neoplasms of the pancreas: definition of preoperative imaging criteria for high-risk lesions. Pancreatology 2011; 11: 495-9. – reference: 28) Nilsson LN, Keane MG, Shamali A, et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature. Pancreatology 2016; 16: 1028-36. – reference: 11) Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann Surg 1999; 230: 152-61. – reference: 17) American Gastroenterological Association. Management of asymptomatic neoplastic pancreatic cysts: clinical decision support tool. Gastroenterology 2015; 148: 823. – reference: 22) Nguyen D, Dawson DW, Hines OJ, Reber HA, Donahue TR. Mucinous cystic neoplasms of the pancreas: are we overestimating malignant potential? Am Surg 2014; 80: 915-9. – reference: 27) Scourtas A, Dudley JC, Brugge WR, Kadayifci A, Mino-Kenudson M, Pitman MB. Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms. Cancer 2017; 125: 169-77. – reference: 14) Lennon AM, Ahuja N, Wolfgang CL. AGA Guidelines for the Management of Pancreatic Cysts. Gastroenterology 2015; 149: 825. – reference: 10) Goh BK, Tan YM, Chung YF, et al. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg 2006; 30: 2236-45. – reference: 12) Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg 2000; 231: 205-12. – reference: 19) Wilentz RE, Albores-Saavedra J, Zahurak M, et al. Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol 1999; 23: 1320-7. – reference: 5) Klöppel G, Solcia E, Longnecker DS, Capella C, Sobin LH; World Health Orginization. International histological classification of tumours. Histological typing of tumours of exocrine pancreas. Second ed. Berlin: Springer-Verlag, 1996. – reference: 4) 大橋計彦, 村上義央, 丸山雅一. 粘液産生膵癌の4例: 特殊な十二指腸乳頭所見を中心にして. Prog Dig Endosc 1982; 20: 348-51. – reference: 20) Testini M, Gurrado A, Lissidini G, Venezia P, Greco L, Piccinni G. Management of mucinous cystic neoplasms of the pancreas. World J Gastroenterol 2010; 16: 5682-92. – reference: 13) Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12: 183-97. – reference: 26) Jang KT, Park SM, Basturk O, et al. Clinicopathologic characteristics of 29 invasive carcinomas arising in 178 pancreatic mucinous cystic neoplasms with ovarian-type stroma: implications for management and prognosis. Am J Surg Pathol 2015; 39: 179-87. – reference: 18) Ducreux M, Cuhna AS, Caramella C, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl 5): v56-68. – reference: 16) Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45: 703-11. – reference: 15) Vege SS, Ziring B, Jain R, Moayyedi P. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819-22; quize812-3. – reference: 29) Postlewait LM, Ethun CG, McInnis MR, et al. Association of Preoperative Risk Factors With Malignancy in Pancreatic Mucinous Cystic Neoplasms: A Multicenter Study. JAMA Surg 2017; 152: 19-25. – reference: 2) Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 1978; 69: 573-80. – reference: 6) Solcia E, Capella C, Kloeppel G. Tumors of the pancreas. In: Rosai J, ed. Atlas of Tumor Pathology. Fascicle 20, 3rd Series. Washington DC: Armed Forces Institute of Pathology, 1997. – reference: 23) Park JW, Jang JY, Kang MJ, Kwon W, Chang YR, Kim SW. Mucinous cystic neoplasm of the pancreas: is surgical resection recommended for all surgically fit patients? Pancreatology 2014; 14: 131-6. |
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| SubjectTerms | 悪性予測因子 悪性度評価 粘液嚢胞性腫瘍 |
| Title | 膵粘液嚢胞性腫瘍（MCN）は全例，切除の適応か？：3つのガイドラインと多数例の後ろ向き観察研究よりみた検討 |
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