Risk Factors for Progression in Patients Undergoing Surveillance for Pancreatic Cysts.

Overview

abstract

OBJECTIVE: To identify risk factors associated with progression of pancreatic cysts in patients undergoing surveillance. SUMMARY BACKGROUND DATA: 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 2010-2019 at a single institution. Cyst progression was defined as resection or pancreatic cancer development. RESULTS: Median follow-up time was 84 months from 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 increased risk of PDAC. Cumulative incidence of progression was 17.8% and 20.0% at 12- and 60-months post-presentation, respectively. Surgical pathology for 417 resected cases showed non-invasive 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 MSKCC. Further investigation is necessary to develop personalized cyst surveillance strategies.