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

Autor: Overbeek KA; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Alblas M; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands., Gausman V; Department of Medicine, NYU - Langone Medical Center, New York, USA., Kandel P; Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, USA., Schweber AB; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, USA., Brooks C; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, USA., Van Riet PA; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Wallace MB; Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, USA., Gonda TA; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, USA., Cahen DL; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Bruno MJ; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2019 Oct; Vol. 50 (7), pp. 789-799. Date of Electronic Publication: 2019 Aug 19.
DOI: 10.1111/apt.15440
Abstrakt: 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.
(© 2019 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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