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Journal of Clinical Gastroenterology Feb 2022Mucinous pancreatic cysts are well reported to transform into pancreatic adenocarcinoma, whereas nonmucinous cysts are mostly benign with low risk for malignant... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mucinous pancreatic cysts are well reported to transform into pancreatic adenocarcinoma, whereas nonmucinous cysts are mostly benign with low risk for malignant transformation. Nonsurgical methods of differentiating mucinous and nonmucinous pancreatic cysts are challenging and entail a multi investigational approach. Low intracystic glucose levels have been evaluated in multiple studies for its accuracy in differentiating mucinous from nonmucinous cysts of the pancreas.
METHODS
Multiple databases were searched and studies that reported on the utility of intracystic glucose levels in diagnosing mucinous pancreatic cysts were analyzed. Meta-analysis was conducted using the random-effects model, heterogeneity was assessed by I2%, and pooled diagnostic test accuracy values were calculated.
RESULTS
Seven studies were included in the analysis from an initial total of 375 citations. The pooled sensitivity of low glucose in differentiating mucinous pancreatic cyst was 90.5% [95% confidence interval (CI): 88.1-92.5; I2=0%] and the pooled specificity was 88% (95% CI: 80.8-92.7; I2=79%). The sensitivity at a glucose cut-off of 50 was 90.1% (95% CI: 87.2-92.5; I2=0%) and the specificity was 85.3% (95% CI: 76.8-91.1; I2=76%). The sensitivity of glucose levels in pancreatic cyst fluid taken by endoscopic ultrasound guided fine-needle aspiration was 90.8% (95% CI: 87.9-93.1; I2=0%) and the specificity was 90.5% (95% CI: 81.7-95.3; I2=83%). The sensitivity of point-of-care glucometers was 89.5% (95% CI: 87.9-93.1; I2=0%) and specificity was 83.9% (95% CI: 68.5-92.6; I2=43%).
CONCLUSIONS
Low glucose level at a cut-off of 50 mg/dL on fluid samples collected by endoscopic ultrasound guided fine-needle aspiration and analyzed by point-of-care glucometer achieves excellent diagnostic accuracy in differentiating mucinous pancreatic cysts.
Topics: Adenocarcinoma; Cyst Fluid; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Glucose; Humans; Pancreatic Cyst; Pancreatic Neoplasms; Sensitivity and Specificity
PubMed: 33731599
DOI: 10.1097/MCG.0000000000001507 -
Cancer Metastasis Reviews Mar 2023Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing neoplastic condition which is poorly understood, with a 5-year progression-free survival rate as low... (Review)
Review
Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing neoplastic condition which is poorly understood, with a 5-year progression-free survival rate as low as 48%. PMP is most commonly caused by appendiceal mucinous neoplasms (AMN), and understanding their genetic biology and pathogenicity may allow for the development of better novel systemic treatments to target key deleterious mutations and the implicated pathways. The primary aim of this systematic review was to identify the genetic profile of histologically confirmed human PMP or AMN samples. The secondary aim was to identify whether genetic marks could be used to predict patient survival. Ovid EMBASE, Ovid MEDLINE, PubMed, and Web of Science were searched to identify studies investigating the genetic profile of histologically-confirmed human PMP or AMN samples. We review findings of 46 studies totalling 2181 tumour samples. The most frequently identified somatic gene mutations in patients with PMP included KRAS (38-100%), GNAS (17-100%), and TP53 (5-23%); however, there were conflicting results of their effect on survival. Three studies identified molecular subtypes based on gene expression profiles classifying patients into oncogene-enriched, immune-enriched, and mixed molecular subtypes with prognostic value. This review summarises the current literature surrounding genetic aberrations in PMP and AMNs and their potential utility for targeted therapy. Given the recent advances in clinical trials to directly target KRAS and GNAS mutations in other cancers, we propose a rationale to explore these mutations in future pre-clinical studies in PMP with a view for a future clinical trial.
Topics: Humans; Pseudomyxoma Peritonei; Peritoneal Neoplasms; Appendiceal Neoplasms; Genetic Profile; Proto-Oncogene Proteins p21(ras)
PubMed: 36723696
DOI: 10.1007/s10555-023-10088-0 -
International Journal of Gynecological... May 2017Overall, patients with mucinous ovarian carcinoma (MOC) are considered to have a better prognosis compared with the whole group of nonmucinous carcinomas. However, some... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Overall, patients with mucinous ovarian carcinoma (MOC) are considered to have a better prognosis compared with the whole group of nonmucinous carcinomas. However, some studies indicate that patients with advanced-stage MOC might have a worse prognosis than those with advanced-stage serous ovarian carcinoma (SOC). We carried out a systematic review and meta-analysis of the current literature.
MATERIALS AND METHODS
A comprehensive literature search was carried out identifying 19 articles that compare survival of patients with MOC and patients with SOC. Meta-analyses were performed for risk ratio (RR) and hazard ratio (HR) for all International Federation of Gynecology and Obstetrics stages together, as well as for early- and advanced-stage diseases separately.
RESULTS
Overall, patients with MOC showed a lower risk of dying within 5 years (RR, 0.67; 95% confidence interval [CI], 0.64-0.69; n = 45 333) and a longer survival (HR, 0.66; 95% CI, 0.58-0.75; HR, 0.88; 95% CI, 0.78-0.98, for univariate and multivariate analyses, respectively; n = 5540) compared with those with SOC. In contrast, in advanced-stage (International Federation of Gynecology and Obstetrics stages III and IV) disease, patients with MOC have a higher risk of dying within 5 years (RR, 1.15; 95% CI, 1.13-1.17; n = 36 113) and a shorter survival (HR, 1.82; 95% CI, 1.71-1.94; n = 19 907).
CONCLUSIONS
Patients with advanced-stage MOC have a significantly worse prognosis compared with patients with SOC, whereas in early stage, the prognosis of patients with MOC is better.
Topics: Adenocarcinoma, Mucinous; Female; Humans; Ovarian Neoplasms; Prognosis
PubMed: 28399027
DOI: 10.1097/IGC.0000000000000932 -
Histopathology Sep 2022Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a recently recognized pancreatic tumor entity. Here we aimed to determine the most important features with... (Review)
Review
AIMS
Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a recently recognized pancreatic tumor entity. Here we aimed to determine the most important features with a systematic review coupled with an integrated statistical approach.
METHODS AND RESULTS
PubMed, SCOPUS, and Embase were searched for studies reporting data on pancreatic ITPN. The clinicopathological, immunohistochemical, and molecular data were summarized. Then a comprehensive survival analysis and a comparative analysis of the molecular alterations of ITPN with those of pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasm (IPMN) from reference cohorts (including the International Cancer Genome Consortium- ICGC dataset and The Cancer Genome Atlas, TCGA program) were conducted. The core findings of 128 patients were as follows: (i) Clinicopathological parameters: pancreatic head is the most common site; presence of an associated adenocarcinoma was reported in 60% of cases, but with rare nodal metastasis. (ii) Immunohistochemistry: MUC1 (>90%) and MUC6 (70%) were the most frequently expressed mucins. ITPN lacked the intestinal marker MUC2; unlike IPMN, it did not express MUC5AC. (iii) Molecular landscape: Compared with PDAC/IPMN, the classic pancreatic drivers KRAS, TP53, CDKN2A, SMAD4, GNAS, and RNF43 were less altered in ITPN (P < 0.001), whereas MCL amplifications, FGFR2 fusions, and PI3KCA mutations were commonly altered (P < 0.001). (iv) Survival analysis: ITPN with a "pure" branch duct involvement showed the lowest risk of recurrence.
CONCLUSION
ITPN is a distinct pancreatic neoplasm with specific clinicopathological and molecular characteristics. Its recognition is fundamental for its clinical/prognostic implications and for the enrichment of potential targets for precision oncology.
Topics: Carcinoma, Pancreatic Ductal; Carcinoma, Papillary; Humans; Pancreas; Pancreatic Intraductal Neoplasms; Pancreatic Neoplasms; Precision Medicine
PubMed: 35583805
DOI: 10.1111/his.14698 -
Digestive Endoscopy : Official Journal... Jul 2014Published studies have revealed the diagnostic yield of cytology obtained from endoscopic retrograde cholangiopancreatography (ERCP) in distinguishing malignant and... (Meta-Analysis)
Meta-Analysis Review
Diagnostic yield of endoscopic retrograde cholangiopancreatography-based cytology for distinguishing malignant and benign intraductal papillary mucinous neoplasm: systematic review and meta-analysis.
BACKGROUND AND AIM
Published studies have revealed the diagnostic yield of cytology obtained from endoscopic retrograde cholangiopancreatography (ERCP) in distinguishing malignant and benign intraductal papillary mucinous neoplasm (IPMN). However as a result of small sample sizes, the overall magnitude of benefit is unknown. Additionally, the optimal endoscopic procedure for cytology acquisition is also unclear. The aim of the present study was to evaluate the diagnostic yield of ERCP-based cytology in patients with IPMN and clarify the optimal sampling technique.
METHODS
Relevant studies with a reference standard of definitive surgical histology were identified via MEDLINE and SCOPUS. Malignant IPMN included invasive adenocarcinoma, carcinoma in situ, and high-grade dysplasia. For ERCP, studies using aspiration, brush, and lavage cytology were included. The main objective was the diagnostic yield (pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio) of cytology obtained from ERCP to distinguish malignant and benign IPMN.
RESULTS
Meta-analysis of 13 international studies with 483 IPMN patients was conducted. Pooled sensitivity was 35.1%, specificity 97.2%, and accuracy 92.9%. Among the three ERCP techniques, lavage cytology showed the best diagnostic ability (sensitivity 45.8%, specificity 97.9%). Malignant IPMN were observed in 45.1% (218/483) of patients in ERCP studies.
CONCLUSIONS
Cytology from ERCP has good specificity but poor sensitivity in distinguishing benign from malignant IPMN. Newer techniques or markers are needed to improve diagnostic yield.
Topics: Adenocarcinoma, Mucinous; Carcinoma, Pancreatic Ductal; Carcinoma, Papillary; Cholangiopancreatography, Endoscopic Retrograde; Cytodiagnosis; Diagnosis, Differential; Humans
PubMed: 24450356
DOI: 10.1111/den.12230 -
American Journal of Surgery Sep 2021Mucinous adenocarcinoma represents a distinct histological subtype of colorectal cancer. To date there has been limited data available for patients with colorectal... (Meta-Analysis)
Meta-Analysis
Clinicopathological characteristics and survival outcomes for patients with mucinous colorectal cancer liver metastases undergoing hepatic resection: A systematic review and meta-analysis.
BACKGROUND
Mucinous adenocarcinoma represents a distinct histological subtype of colorectal cancer. To date there has been limited data available for patients with colorectal cancer liver metastases (CRCLM) derived from mucinous adenocarcinoma. This systematic review and meta-analysis aims to provide data on the clinicopathological and survival outcomes of this cohort.
METHODS
Databases were searched for studies comparing clinicopathological and survival outcomes between patients with mucinous CRCLM and CRCLM from adenocarcinoma not otherwise specified who underwent liver resection. A random-effects model was used for analysis.
RESULTS
Eight studies describing 9157 patients were included. Mucinous CRCLM were positively associated with colon tumors (OR 1⋅64, P = 0⋅01), T3/T4 tumors (OR 1⋅58, P = 0⋅02), node positive tumors (OR 1⋅55, P = 0⋅005). The review also identified a trend towards worse overall survival in patients with mucinous CRCLM.
CONCLUSIONS
Despite the distinct clinicopathological characteristics and impaired long term outcomes of mucinous CRCLM, resection should remain the gold standard where possible.
Topics: Adenocarcinoma; Adenocarcinoma, Mucinous; Age Factors; Colonic Neoplasms; Colorectal Neoplasms; Databases, Factual; Female; Hepatectomy; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Rectal Neoplasms; Sex Factors
PubMed: 33750573
DOI: 10.1016/j.amjsurg.2021.02.031 -
Clinical Gastroenterology and... Oct 2017It is not clear how best to manage patients with low-risk intraductal papillary mucinous neoplasms (IPMNs) of the pancreas because little is known about IPMN progression... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
It is not clear how best to manage patients with low-risk intraductal papillary mucinous neoplasms (IPMNs) of the pancreas because little is known about IPMN progression to cancer. We sought to determine the cumulative incidence of development of pancreatic cancer in persons with unresected IPMNs (particularly low-risk IPMNs).
METHODS
We performed a systematic search of the MEDLINE and Embase databases through November 30, 2016 for studies reporting the cumulative incidence of pancreatic cancer in patients with unresected IPMNs or studies that provided data in sufficient detail for us to calculate cumulative incidence values. We categorized patient series as studies on low-risk IPMNs (lesions without main pancreatic duct involvement or mural nodules) or non-low-risk IPMNs. We calculated meta-analytic cumulative incidence values for pancreatic cancer at 1, 3, 5, and 10 years of follow-up by using the inverse variance method and random-effects model.
RESULTS
Among 1514 articles screened, we identified 10 studies of low-risk IPMNs (n = 2411) and 9 studies of non-low-risk IPMNs (n = 825). In studies of low-risk IPMNs, the meta-analytic cumulative incidence values for pancreatic cancer were 0.02% at 1 year (95% confidence interval [CI], 0.0%-0.23%; I= 0.0%), 1.40% at 3 years (95% CI, 0.58%-2.48%; I = 58.5%), 3.12% at 5 years (95% CI, 1.12%-5.90%; I = 88.0%), and 7.77% at 10 years (95% CI, 4.09%-12.39%; I = 79.8%). These values were much higher in studies of non-low-risk IPMNs; cumulative incidence values for pancreatic cancer were 1.95% at 1 year (95% CI, 0.0%-5.99%; I = 84.2%), 5.69% at 3 years (95% CI, 1.10%-12.77%; I = 89.9%), 9.77% at 5 years (95% CI, 3.04%-19.27%; I = 92.0%), and 24.68% at 10 years (95% CI, 14.87%-35.90%; I = 74.3%). The pooled cumulative incidence steadily increased linearly as the follow-up duration increased.
CONCLUSIONS
In a systematic review and meta-analysis, we found that low-risk IPMNs have almost 8% chance of progressing to pancreatic cancer within 10 years, and higher-risk IPMNs have almost 25% chance of progressing to cancer in 10 years; incidence values increase linearly with time. Continued long-term surveillance is therefore vital for patients with low-risk IPMNs.
Topics: Adenocarcinoma, Mucinous; Carcinoma, Pancreatic Ductal; Disease Progression; Humans; Incidence; Pancreatic Neoplasms; Risk Assessment
PubMed: 28342950
DOI: 10.1016/j.cgh.2017.03.020 -
Pancreas Oct 2016This study aimed to evaluate the accuracy of the risk factors proposed by Fukuoka guidelines in detecting malignancy of branch-duct intraductal papillary mucinous... (Meta-Analysis)
Meta-Analysis Review
Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms: A Critical Evaluation of the Fukuoka Guidelines With a Systematic Review and Meta-analysis.
OBJECTIVES
This study aimed to evaluate the accuracy of the risk factors proposed by Fukuoka guidelines in detecting malignancy of branch-duct intraductal papillary mucinous neoplasms.
METHOD
Diagnostic meta-analysis of cohort studies. A systematic literature search was conducted using MEDLINE, the Cochrane Library, Scopus, and the ISI-Web of Science databases to identify all studies published up to 2014.
RESULTS
Twenty-five studies (2025 patients) were suitable for the meta-analysis. The "high risk stigmata" showed the highest pooled diagnostic odds ratio (jaundice, 6.3; positive citology, 5.5; mural nodules, 4.8) together with 2 "worrisome features" (thickened/enhancing walls, 4.2; duct dilatation, 4.0) and 1 "other parameters" (carbohydrate antigen 19-9 serum levels, 4.6).
CONCLUSIONS
An "ideal risk factor" capable of recognizing all malignant branch-duct intraductal papillary mucinous neoplasms was not identified and some "dismal areas" remain. However, "high risk stigmata" were strongly related to malignancy, mainly enhancing mural nodules. Among the "worrisome features," duct dilatation and thickened/enhancing walls were underestimated, and their diagnostic performance was similar to those of "high risk stigmata." The carbohydrate antigen 19-9 serum level should be added to the Fukuoka algorithm because this value could help in carrying out correct management.
Topics: Adenocarcinoma, Mucinous; Carcinoma, Pancreatic Ductal; Humans; Pancreatic Neoplasms; Risk Factors
PubMed: 27776043
DOI: 10.1097/MPA.0000000000000642 -
European Urology Jul 2023The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for...
Impact of Epithelial Histological Types, Subtypes, and Growth Patterns on Oncological Outcomes for Patients with Nonmetastatic Prostate Cancer Treated with Curative Intent: A Systematic Review.
CONTEXT
The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for conventional PCa and so different approaches may be needed.
OBJECTIVE
To compare oncological outcomes for conventional and UH PCa in men with localized disease treated with curative intent.
EVIDENCE ACQUISITION
A systematic review adhering to the Referred Reporting Items for Systematic Reviews and Meta-Analyses was prospectively registered on PROSPERO (CRD42022296013) was performed in July 2021.
EVIDENCE SYNTHESIS
We screened 3651 manuscripts and identified 46 eligible studies (reporting on 1 871 814 men with conventional PCa and 6929 men with 10 different PCa UHs). Extraprostatic extension and lymph node metastases, but not positive margin rates, were more common with UH PCa than with conventional tumors. PCa cases with cribriform pattern, intraductal carcinoma, or ductal adenocarcinoma had higher rates of biochemical recurrence and metastases after radical prostatectomy than for conventional PCa cases. Lower cancer-specific survival rates were observed for mixed cribriform/intraductal and cribriform PCa. By contrast, pathological findings and oncological outcomes for mucinous and prostatic intraepithelial neoplasia (PIN)-like PCa were similar to those for conventional PCa. Limitations of this review include low-quality studies, a risk of reporting bias, and a scarcity of studies that included radiotherapy.
CONCLUSIONS
Intraductal, cribriform, and ductal UHs may have worse oncological outcomes than for conventional and mucinous or PIN-like PCa. Alternative treatment approaches need to be evaluated in men with these cancers.
PATIENT SUMMARY
We reviewed the literature to explore whether prostate cancers with unconventional growth patterns behave differently to conventional prostate cancers. We found that some unconventional growth patterns have worse outcomes, so we need to investigate if they need different treatments. Urologists should be aware of these growth patterns and their clinical impact.
Topics: Humans; Male; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Intraepithelial Neoplasia; Prostatic Neoplasms
PubMed: 37117107
DOI: 10.1016/j.eururo.2023.03.014 -
Techniques in Coloproctology Apr 2014The definition of mucinous tumours relies on quantification of the amount of mucus produced by neoplastic cells within the rectum. This has changed over the years to... (Review)
Review
PURPOSE
The definition of mucinous tumours relies on quantification of the amount of mucus produced by neoplastic cells within the rectum. This has changed over the years to include varying degrees of mucin production. The inconsistency of diagnosis has led to conflicting reports in the literature regarding clinical outcomes and treatment response. A universally accepted definition and improved imaging and surgical techniques in the last decade are now challenging the traditional view of these tumours. The aim of this review was to present the current evidence on the clinicopathological characteristics of mucinous tumours of the rectum.
METHODS
A systematic review was conducted using Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. A literature search was performed using the Ovid SP to search both EMBASE and MEDLINE databases, Google Scholar and PubMed to find all studies relating to mucinous carcinoma of the rectum. The search dates were between 1 January 1965 and 1 March 2013.
RESULTS
Mucinous tumours comprise 5-20 % of all rectal cancers and commonly present at a more advanced stage and in younger patients. They are readily identified on MRI, and the diagnosis is confirmed on histological analysis, demonstrating more than 50 % of extracellular mucin within the tumour complex. They carry an overall worse prognosis compared to adenocarcinoma of the same stage. The response to oncological treatment remains controversial.
CONCLUSION
Mucinous tumours of the rectum are less well understood than non-mucinous adenocarcinoma. This is due to the inconsistent histopathological definitions of the past making comparison of clinical outcome data difficult. They remain challenging to treat and are associated with a poor prognosis. A universally accepted definition and the role of imaging techniques such as MRI to accurately detect mucinous tumours are likely to lead to a better understanding of these cancers.
Topics: Adenocarcinoma, Mucinous; Humans; Prognosis; Rectal Neoplasms; Treatment Outcome
PubMed: 24326828
DOI: 10.1007/s10151-013-1099-3