@article{76e15bf7821541f79cc9d46efbdc33d4,
title = "Predictors of progression among low-risk intraductal papillary mucinous neoplasms in a multicenter surveillance cohort",
abstract = "Objectives Our aim was to identify baseline characteristics associated with disease progression and malignant transformation in low-risk suspected intraductal papillary mucinous neoplasms (IPMNs). Methods This is a retrospective cohort study of prospectively maintained databases of pancreatic cysts at 3 international, academic institutions. Five hundred fifty-nine adult patients with clinically suspected asymptomatic IPMN evaluated by radiologic studies or endoscopic ultrasound between 2003 and 2013 without worrisome features and under surveillance for 12 months or longer were included. We evaluated the relationship of baseline demographics and cyst features to disease progression (size increase, development of worrisome features, or high-grade dysplasia/cancer). Results After a median of 44 months follow-up, 269 (48%) patients experienced cyst size increase, 68 (12%) developed worrisome features, and 11 (2%) developed high-grade dysplasia/cancer. In multivariable Cox-regression analysis, no baseline characteristics were associated with size increase. An initial cyst size of 2 cm or greater, multifocality, history of prostate cancer, and smoking were the strongest predictors of development of new worrisome features. Univariable analysis found male sex, diabetes, and recent weight loss associated with development of high-grade dysplasia/cancer. Conclusions Our study demonstrates that low-risk suspected IPMNs carry a small but clinically relevant risk of disease progression and provides data on baseline characteristics that may help in risk stratification.",
keywords = "Disease progression, Low risk, Pancreatic cysts, Risk factors, Surveillance",
author = "Valerie Gausman and Pujan Kandel and {Van Riet}, {Priscilla A.} and Maria Moris and Maia Kayal and Catherine Do and Poneros, {John M.} and Amrita Sethi and Gress, {Frank G.} and Schrope, {Beth A.} and Lyndon Luk and Elizabeth Hecht and Manol Jovani and Bruno, {Marco J.} and Cahen, {Djuna L.} and Wallace, {Michael B.} and Gonda, {Tamas A.}",
note = "Funding Information: From the *Department of Medicine, NYU–Langone Medical Center, New York, NY; †Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; ‡Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands; §Division of Digestive and Liver Diseases, Department of Medicine, ||Herbert Irving Cancer Center, ¶Department of Surgery, #Department of Radiology, Columbia University Medical Center, New York, NY; and **Clinical and Translational Epidemiology Unit, Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Received for publication September 21, 2017; accepted February 2, 2018. Address correspondence to: Tamas A. Gonda, MD, Division of Digestive and Liver Diseases, Department of Medicine, 161 Fort Washington Ave, Herbert Irving Pavilion, Rm 852A, New York, NY 10032 (e‐mail: tg2214@cumc.columbia.edu). The authors declare no conflict of interest. M.B.W. receives research funding from BSCI, Medtronic. M.J.B. is a consultant and lecturer for Boston Scientific and Cook Medical. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal{\textquoteright}s Web site (www.pancreasjournal.com). Copyright {\textcopyright} 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001027 Publisher Copyright: {\textcopyright} 2018 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2018",
month = apr,
day = "1",
doi = "10.1097/MPA.0000000000001027",
language = "English (US)",
volume = "47",
pages = "471--476",
journal = "Pancreas",
issn = "0885-3177",
publisher = "Lippincott Williams and Wilkins",
number = "4",
}