Article Text
Abstract
Objective Cost-effectiveness of surveillance for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) is debated. We combined different categories of risks of IPMN progression and of IPMN-unrelated mortality to improve surveillance strategies.
Design Retrospective analysis of 926 presumed BD-IPMNs lacking worrisome features (WFs)/high-risk stigmata (HRS) under surveillance. Charlson Comorbidity Index (CACI) defined the severity of comorbidities. IPMN relevant changes included development of WF/HRS, pancreatectomy or death for IPMN or pancreatic cancer. Pancreatic malignancy-unrelated death was recorded. Cumulative incidence of IPMN relevant changes were estimated using the competing risk approach.
Results 5-year cumulative incidence of relevant changes was 17.83% and 1.6% developed pancreatic malignancy. 5-year cumulative incidences for IPMN relevant changes were 13.73%, 19.93% and 25.04% in low-risk, intermediate-risk and high-risk groups, respectively. Age ≥75 (HR: 4.15) and CACI >3 (HR: 3.61) were independent predictors of pancreatic malignancy-unrelated death. 5-year cumulative incidence for death for other causes was 15.93% for age ≥75+CACI >3 group and 1.49% for age <75+CACI ≤3. 5-year cumulative incidence of IPMN relevant changes were 13.94% in patients with age <75+CACI ≤3 compared with 29.60% in those with age ≥75+CACI >3. In this group 5-year rate of malignancy-free patients was 95.56% with a 5-year survival of 79.51%.
Conclusion Although it is not uncommon the occurrence of changes considered by current guidelines as relevant during surveillance of low risk BD-IPMNs, malignancy rate is low and survival is significantly affected by competing patients’ age and comorbidities. IPMN surveillance strategy should be tailored based on these features and modulated over time.
- abdominal MRI
- pancreatic cancer
- pancreatic surgery
- pancreatic tumours
- surveillance
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
SC, GM and GB are joint first authors.
RS and MF are joint senior authors.
X @StefanoCrippa6, @Gio_Marchegiani, @a_burez
Contributors SC, GM, GB: study design, data analysis, interpretation of results, manuscript and tables preparation; PMVR and MGS: statistical analysis, interpretation of results, figures and tables preparation; TP, AB, LA, DS, MB, GV: data acquisition and interpretation of results; GC and PGA: study design and methodological advice; RS: project supervision, study design, interpretation of results, manuscript preparation; MF: project supervision, study design, interpretation of results, manuscript preparation and guarantor of this project. All authors read and approved the final paper. SC, GM and GB share the first authorship. RS and MF are last authors.
Funding This work was supported by a Grant from Fondazione Nadia Valsecchi to Stefano Crippa.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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