Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Kasper A. Overbeek, Maaike Alblas, Valerie Gausman, Pujan Kandel, Adam B. Schweber, Christian Brooks, Priscilla A. Van Riet, Michael B Wallace, Tamas A. Gonda, Djuna L. Cahen, Marco J. Bruno

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long-term surveillance is low-yield for most individuals. Aim: To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high-risk stigmata. Methods: We combined prospectively maintained pancreatic cyst surveillance databases of three academic institutions. Patients were included if they had a presumed side-branch IPMN, without worrisome features or high-risk stigmata at baseline (as defined by the 2012 international Fukuoka guidelines), and were followed ≥ 12 months. The endpoint was development of one or more worrisome features or high-risk stigmata during follow-up. We created a multivariable prediction model using Cox-proportional logistic regression analysis and performed an internal-external validation. Results: 875 patients were included. After a mean follow-up of 50 months (range 12-157), 116 (13%) patients developed worrisome features or high-risk stigmata. The final model included cyst size (HR 1.12, 95% CI 1.09-1.15), cyst multifocality (HR 1.49, 95% CI 1.01-2.18), ever having smoked (HR 1.40, 95% CI 0.95-2.04), history of acute pancreatitis (HR 2.07, 95% CI 1.21-3.55), and history of extrapancreatic malignancy (HR 1.34, 95% CI 0.91-1.97). After validation, the model had good discriminative ability (C-statistic 0.72 in the Mayo cohort, 0.71 in the Columbia cohort, 0.64 in the Erasmus cohort). Conclusion: In presumed side branch IPMNs without worrisome features or high-risk stigmata at baseline, the Dutch-American Risk stratification Tool (DART-1) successfully identifies pancreatic lesions at low risk of developing worrisome features or high-risk stigmata.

Original languageEnglish (US)
JournalAlimentary Pharmacology and Therapeutics
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Christianity
Neoplasms
Cysts
Pancreatic Cyst
Proportional Hazards Models
Pancreatitis
Logistic Models
Regression Analysis
Databases
Guidelines

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression. / Overbeek, Kasper A.; Alblas, Maaike; Gausman, Valerie; Kandel, Pujan; Schweber, Adam B.; Brooks, Christian; Van Riet, Priscilla A.; Wallace, Michael B; Gonda, Tamas A.; Cahen, Djuna L.; Bruno, Marco J.

In: Alimentary Pharmacology and Therapeutics, 01.01.2019.

Research output: Contribution to journalArticle

Overbeek, KA, Alblas, M, Gausman, V, Kandel, P, Schweber, AB, Brooks, C, Van Riet, PA, Wallace, MB, Gonda, TA, Cahen, DL & Bruno, MJ 2019, 'Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression', Alimentary Pharmacology and Therapeutics. https://doi.org/10.1111/apt.15440
Overbeek, Kasper A. ; Alblas, Maaike ; Gausman, Valerie ; Kandel, Pujan ; Schweber, Adam B. ; Brooks, Christian ; Van Riet, Priscilla A. ; Wallace, Michael B ; Gonda, Tamas A. ; Cahen, Djuna L. ; Bruno, Marco J. / Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression. In: Alimentary Pharmacology and Therapeutics. 2019.
@article{61a414d588124a1aa0c1d4476882582f,
title = "Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression",
abstract = "Background: Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long-term surveillance is low-yield for most individuals. Aim: To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high-risk stigmata. Methods: We combined prospectively maintained pancreatic cyst surveillance databases of three academic institutions. Patients were included if they had a presumed side-branch IPMN, without worrisome features or high-risk stigmata at baseline (as defined by the 2012 international Fukuoka guidelines), and were followed ≥ 12 months. The endpoint was development of one or more worrisome features or high-risk stigmata during follow-up. We created a multivariable prediction model using Cox-proportional logistic regression analysis and performed an internal-external validation. Results: 875 patients were included. After a mean follow-up of 50 months (range 12-157), 116 (13{\%}) patients developed worrisome features or high-risk stigmata. The final model included cyst size (HR 1.12, 95{\%} CI 1.09-1.15), cyst multifocality (HR 1.49, 95{\%} CI 1.01-2.18), ever having smoked (HR 1.40, 95{\%} CI 0.95-2.04), history of acute pancreatitis (HR 2.07, 95{\%} CI 1.21-3.55), and history of extrapancreatic malignancy (HR 1.34, 95{\%} CI 0.91-1.97). After validation, the model had good discriminative ability (C-statistic 0.72 in the Mayo cohort, 0.71 in the Columbia cohort, 0.64 in the Erasmus cohort). Conclusion: In presumed side branch IPMNs without worrisome features or high-risk stigmata at baseline, the Dutch-American Risk stratification Tool (DART-1) successfully identifies pancreatic lesions at low risk of developing worrisome features or high-risk stigmata.",
author = "Overbeek, {Kasper A.} and Maaike Alblas and Valerie Gausman and Pujan Kandel and Schweber, {Adam B.} and Christian Brooks and {Van Riet}, {Priscilla A.} and Wallace, {Michael B} and Gonda, {Tamas A.} and Cahen, {Djuna L.} and Bruno, {Marco J.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/apt.15440",
language = "English (US)",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

AU - Overbeek, Kasper A.

AU - Alblas, Maaike

AU - Gausman, Valerie

AU - Kandel, Pujan

AU - Schweber, Adam B.

AU - Brooks, Christian

AU - Van Riet, Priscilla A.

AU - Wallace, Michael B

AU - Gonda, Tamas A.

AU - Cahen, Djuna L.

AU - Bruno, Marco J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long-term surveillance is low-yield for most individuals. Aim: To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high-risk stigmata. Methods: We combined prospectively maintained pancreatic cyst surveillance databases of three academic institutions. Patients were included if they had a presumed side-branch IPMN, without worrisome features or high-risk stigmata at baseline (as defined by the 2012 international Fukuoka guidelines), and were followed ≥ 12 months. The endpoint was development of one or more worrisome features or high-risk stigmata during follow-up. We created a multivariable prediction model using Cox-proportional logistic regression analysis and performed an internal-external validation. Results: 875 patients were included. After a mean follow-up of 50 months (range 12-157), 116 (13%) patients developed worrisome features or high-risk stigmata. The final model included cyst size (HR 1.12, 95% CI 1.09-1.15), cyst multifocality (HR 1.49, 95% CI 1.01-2.18), ever having smoked (HR 1.40, 95% CI 0.95-2.04), history of acute pancreatitis (HR 2.07, 95% CI 1.21-3.55), and history of extrapancreatic malignancy (HR 1.34, 95% CI 0.91-1.97). After validation, the model had good discriminative ability (C-statistic 0.72 in the Mayo cohort, 0.71 in the Columbia cohort, 0.64 in the Erasmus cohort). Conclusion: In presumed side branch IPMNs without worrisome features or high-risk stigmata at baseline, the Dutch-American Risk stratification Tool (DART-1) successfully identifies pancreatic lesions at low risk of developing worrisome features or high-risk stigmata.

AB - Background: Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long-term surveillance is low-yield for most individuals. Aim: To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high-risk stigmata. Methods: We combined prospectively maintained pancreatic cyst surveillance databases of three academic institutions. Patients were included if they had a presumed side-branch IPMN, without worrisome features or high-risk stigmata at baseline (as defined by the 2012 international Fukuoka guidelines), and were followed ≥ 12 months. The endpoint was development of one or more worrisome features or high-risk stigmata during follow-up. We created a multivariable prediction model using Cox-proportional logistic regression analysis and performed an internal-external validation. Results: 875 patients were included. After a mean follow-up of 50 months (range 12-157), 116 (13%) patients developed worrisome features or high-risk stigmata. The final model included cyst size (HR 1.12, 95% CI 1.09-1.15), cyst multifocality (HR 1.49, 95% CI 1.01-2.18), ever having smoked (HR 1.40, 95% CI 0.95-2.04), history of acute pancreatitis (HR 2.07, 95% CI 1.21-3.55), and history of extrapancreatic malignancy (HR 1.34, 95% CI 0.91-1.97). After validation, the model had good discriminative ability (C-statistic 0.72 in the Mayo cohort, 0.71 in the Columbia cohort, 0.64 in the Erasmus cohort). Conclusion: In presumed side branch IPMNs without worrisome features or high-risk stigmata at baseline, the Dutch-American Risk stratification Tool (DART-1) successfully identifies pancreatic lesions at low risk of developing worrisome features or high-risk stigmata.

UR - http://www.scopus.com/inward/record.url?scp=85070796197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070796197&partnerID=8YFLogxK

U2 - 10.1111/apt.15440

DO - 10.1111/apt.15440

M3 - Article

C2 - 31429105

AN - SCOPUS:85070796197

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

ER -