Small cyst size and lack of growth as negative predictors of malignant transformation in low-risk intraductal papillary mucinous neoplasms of the pancreas: A systematic review and meta-analysis.

Autor: Meziani J; Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands., Sprij MLJA; Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands.; Department of Public Health, University Medical Center Rotterdam, Rotterdam, The Netherlands., Fuhler GM; Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands., Bruno MJ; Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands., Marchegiani G; Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepato Pancreato Biliary and Liver Transplant Surgery, University of Padua, Padua, Italy., Cahen DL; Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: United European gastroenterology journal [United European Gastroenterol J] 2024 Oct 06. Date of Electronic Publication: 2024 Oct 06.
DOI: 10.1002/ueg2.12666
Abstrakt: Background and Aim: For branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WFs) or high-risk stigmata (HRS), current guidelines recommend surveillance. However, these intraductal papillary mucinous neoplasm (IPMNs), especially the small and stable-sized ones, carry a low risk of malignant transformation. Our aim was to assess whether small cyst size and absence of rapid growth provide reassurance against the development of WFs/HRS and malignancy (high-grade dysplasia (HGD) or pancreatic cancer (PC)).
Methods: PubMed/Medline, Embase, the Cochrane Library and the Web of Science Core Collection were systematically searched from inception to May 2023 to identify studies investigating surveillance outcomes of low-risk BD-IPMNs. Studies assessing baseline cyst size and/or growth in relation to WFs/HRS and/or HGD/PC were included. The Newcastle-Ottawa scale tool was used to assess study quality.
Results: Of the 1937 identified manuscripts, 21 studies were eligible for inclusion. The quality of these studies was considered reasonable. A negative association between cyst size and WFs/HRS development was found in 11 out of 13 relevant studies, but only one out of nine studies reported a negative association between size and malignancy. Regarding cyst growth, four out of six studies described a negative association with the development of WFs/HRS, and all six reported a negative association with malignancy. The pooled relative risk (RR) of developing WFs/HRS or malignancy for cysts ≤15 mm was 0.37 (95% CI 0.25-0.57) and the RR of developing malignancy for cyst growth <2-2.5 mm/year was 0.04 (95% CI 0.02-0.09)).
Conclusion: This systematic review and meta-analysis shows that small and stable-sized low-risk BD-IPMNs are associated with a markedly low progression rate, with stable cyst size being the most reassuring feature. Because of substantial heterogeneity in definitions and reported outcome measures, prospective studies are needed to confirm that surveillance of small and stable sized cyst can be de-intensified or even discontinued.
(© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)
Databáze: MEDLINE
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