Risk factors for progression in patients undergoing surveillance for pancreatic cysts Journal Article
| Authors: | Armstrong, M. T.; Saadat, L. V.; Chou, J. F.; Gönen, M.; Balachandran, V. P.; D'Angelica, M. I.; Drebin, J. A.; Flood, J. A.; Jarnagin, W. R.; Kingham, T. P.; Rolston, V. S.; Schattner, M. A.; Wei, A. C.; Soares, K. C. |
| Article Title: | Risk factors for progression in patients undergoing surveillance for pancreatic cysts |
| Abstract: | Objective: To identify risk factors associated with the progression of pancreatic cysts in patients undergoing surveillance. Background: Previous studies of intraductal papillary mucinous neoplasms (IPMNs) rely on surgical series to determine malignancy risk and have inconsistently identified characteristics associated with IPMN progression. Methods: We conducted a retrospective review of 2197 patients presenting with imaging concerning for IPMN from 2010 to 2019 at a single institution. Cyst progression was defined as resection or pancreatic cancer development. Results: The median follow-up time was 84 months from the presentation. The median age was 66 years, and 62% were female. Ten percent had a first-degree relative with pancreatic cancer, and 3.2% had a germline mutation or genetic syndrome associated with an increased risk of pancreatic ductal adenocarcinoma (PDAC). Cumulative incidence of progression was 17.8% and 20.0% at 12 and 60 months postpresentation, respectively. Surgical pathology for 417 resected cases showed noninvasive IPMN in 39% of cases and PDAC with or without associated IPMN in 20%. Only 18 patients developed PDAC after 6 months of surveillance (0.8%). On multivariable analysis, symptomatic disease [hazard ratio (HR)=1.58; 95% CI: 1.25-2.01], current smoker status (HR=1.58; 95% CI: 1.16-2.15), cyst size (HR=1.26; 95% CI: 1.20-1.33), main duct dilation (HR=3.17; 95% CI: 2.44-4.11), and solid components (HR=1.89; 95% CI: 1.34-2.66) were associated with progression. Conclusions: Worrisome features on imaging at presentation, current smoker status, and symptomatic presentation are associated with IPMN progression. Most patients progressed within the first year of presentation to Memorial Sloan Kettering Cancer Center (MSKCC). Further investigation is necessary to develop personalized cyst surveillance strategies. © 2024 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | adult; controlled study; human tissue; aged; major clinical study; overall survival; histopathology; cancer risk; pancreas cancer; follow up; prospective study; intraductal papillary mucinous tumor; pancreas cyst; cohort analysis; genetic association; patient monitoring; retrospective study; risk factor; progression; pancreatic cancer; disease exacerbation; surveillance; cumulative incidence; intraductal papillary mucinous neoplasms; pancreatic ductal carcinoma; pancreas surgery; germline mutation; first-degree relative; human; male; female; article; people by smoking status; current smoker |
| Journal Title: | Annals of Surgery |
| Volume: | 279 |
| Issue: | 1 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-01-01 |
| Start Page: | 119 |
| End Page: | 124 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000005922 |
| PUBMED: | 37212166 |
| PROVIDER: | scopus |
| PMCID: | PMC10663383 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Kevin C. Soares -- Source: Scopus |
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