胰腺黏液性囊性肿瘤是罕见的肿瘤，具有潜在的癌变可能性。目前尚未就这些肿瘤的高风险特征达成共识。我们的研究旨在确定能够预测胰腺黏液性囊性肿瘤中高级别异型增生或浸润癌前手术阶段的人口统计学、临床或放射学因素。我们在三十年（1990-2020）的前瞻性数据库中识别了157位接受切除手术且符合胰腺黏液性囊性肿瘤病理标准的患者。我们使用多变量 Logistic 回归模型来识别影响胰腺黏液性囊性肿瘤中高级别异型增生或浸润癌的因素。高级别异型增生或浸润癌的发生率为11%。肿瘤直径≥4 cm（P<0.001）、壁结节（P=0.04）和血清 CA 19-9 > 37 U/mL（P<0.001）与高级别异型增生或浸润癌呈正相关。在多元回归分析中，肿瘤直径≥4 cm（优势比为16.9，95%可信区间2.04-140，P=0.009）和 CA 19-9 >37 U/mL（优势比为5.68，95%可信区间1.52-21.3，P=0.010）是胰腺黏液性囊性肿瘤中高级别异型增生或浸润癌的预测因素。未出现 CA 19-9 升高或壁结节，肿瘤直径<4 cm 的患者中没有发现高级别异型增生或浸润癌的肿瘤。肿瘤直径≥4 cm 和/或高 CA 19-9 应考虑及时手术切除。相反，没有其他高危因素的<4 cm 的肿瘤具有可以忽略的高级别异型增生或浸润癌风险，并且可能受益于非手术监测。壁结节是另一个可疑特征。这些研究结果可能有助于未来制定指南。版权所有©2023 Elsevier Inc.。

Mucinous cystic neoplasms of the pancreas are uncommon tumors that have the potential of becoming cancer. There is no consensus regarding the high-risk features of these tumors. Our study aimed to identify the preoperative demographic, clinical, or radiologic factors that can predict the presence of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas.We identified 157 patients who underwent resection and fulfilled the pathologic criteria for mucinous cystic neoplasms of the pancreas in a prospectively maintained database spanning 3 decades (1990-2020). Multivariable logistic regression was used to identify predictors of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas.The rate of high-grade dysplasia or invasive carcinoma was 11%. Tumor size ≥4 cm (P < .001), mural nodularity (P = .04), and a serum CA 19-9 level >37 U/mL (P < .001) were associated with high-grade dysplasia or invasive carcinoma. In the multivariable analysis, tumor size ≥4 cm (odds ratio 16.9, 95% confidence interval 2.04-140, P = .009) and a CA 19-9 level >37 U/mL (odds ratio 5.68, 95% confidence interval 1.52-21.3, P = .010) were predictors of high-grade dysplasia or invasive carcinoma. There were no tumors with high-grade dysplasia or invasive carcinoma in patients with tumor size <4 cm in the absence of an elevated CA 19-9 or mural nodularity.Tumors with a size ≥4 cm and/or a high CA 19-9 level should be considered for prompt surgical resection. Conversely, tumors <4 cm with no other high-risk features have a negligible risk for high-grade dysplasia or invasive carcinoma and may benefit from nonoperative surveillance. Mural nodularity is an additional suspicious feature. These findings may contribute to future guidelines.Copyright © 2023 Elsevier Inc. All rights reserved.