title: Tumor size and location correlate with behavior of pancreatic serous cystic neoplasms.
abstract: OBJECTIVE
  The majority of pancreatic serous cystic neoplasms (SCNs) are benign. However, these neoplasms can cause symptoms and rarely can be aggressive. Identification of factors associated with symptomatic or aggressive SCNs may aid management decisions. The aim of this study was to identify variables that predict aggressive SCNs.
  
  
  METHODS
  Prospective pathology database was queried for SCNs that were surgically resected at Johns Hopkins Hospital. Tumors were considered aggressive if they invaded surrounding structures and/or vessels or if they metastasized to lymph nodes or distant organs. The associations of gender, tumor size, and tumor location, with the presence or absence of symptoms and tumor behavior were examined using Fisher's exact test, logistic regression, and multivariate analyses.
  
  
  RESULTS
  A total of 257 patients with SCNs underwent surgical resection. Mean tumor diameter was 4.9 cm. Tumor location in the head of pancreas (HOP) was associated with symptoms (odds ratio (OR) 1.87, 95% confidence interval (CI) 1.1-3.3). Computed tomography (CT) predicted the diagnosis of SCN in approximately a quarter of patients. Thirteen tumors (mean 10.5 cm) were considered aggressive. Multivariate analysis showed that tumor diameter (OR 1.53, 95% CI 1.24-1.89) and location of tumor in pancreatic head (OR 10.44, 95% CI 1.73-63.04) were independently associated with aggressive behavior.
  
  
  CONCLUSIONS
  We describe the largest case series of patients with pathologically proven SCNs. CT performed poorly in preoperative diagnosis of SCNs. Large tumor size and head location predicted aggressive behavior. These factors should be considered in the management of patients with SCN.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Shin
authors.forename: Stuart
authors.initials: S
authors.lastname: Amateau
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Samuel
authors.initials: S
authors.lastname: Giday
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002779:Cholestasis / Q000209:etiology; D018293:Cystadenoma, Serous / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D015431:Weight Loss