Impact of age, comorbidities and relevant changes on surveillance strategy of intraductal papillary mucinous neoplasms: a competing risk analysis.

Autor:	Crippa S; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy., Marchegiani G; Division of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, GB Rossi Hospital, Verona, Italy., Belfiori G; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy., Rancoita PVM; University Center of Statistics in the Biomedical Sciences, Vita Salute San Raffaele University, Milan, Italy., Pollini T; Division of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, GB Rossi Hospital, Verona, Italy., Burelli A; Division of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, GB Rossi Hospital, Verona, Italy., Apadula L; Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy., Scarale MG; University Center of Statistics in the Biomedical Sciences, Vita Salute San Raffaele University, Milan, Italy., Socci D; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy., Biancotto M; Division of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, GB Rossi Hospital, Verona, Italy., Vanella G; Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy., Arcidiacono PG; Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy., Capurso G; Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy., Salvia R; Division of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, GB Rossi Hospital, Verona, Italy., Falconi M; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy falconi.massimo@hsr.it.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2024 Jul 11; Vol. 73 (8), pp. 1336-1342. Date of Electronic Publication: 2024 Jul 11.
DOI:	10.1136/gutjnl-2023-329961
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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