Risk Factors for Pancreatic Cancer and the Necessity of Long-Term Surveillance in Patients With Pancreatic Cystic Lesions

Abstract

Objectives Pancreatic cystic lesions (PCLs) are a risk factor for pancreatic cancer (PC). Which PCLs should be surveilled and necessity of long-term observation are still controversial. Methods From January 2000 to March 2016, we enrolled 1137 patients with PCLs observed for 1 year. We defined PCLs with cyst size of greater than 30 mm, main pancreatic duct (MPD) of greater than 5 mm or mural nodule as high-risk group, and others as low-risk group (LRG). Kaplan-Meier method and Cox proportional hazard model were applied to assess incidence and risk factors of PC. Results In 107 high-risk group and 1030 LRG patients, mean observation period was 4.3 years and 5.0 years, respectively, and 5-year PC incidence was 12.0% and 2.8%, respectively. In LRG, MPD of greater than 3 mm, diabetes mellitus, and presumed branch-duct intraductal papillary mucinous neoplasia (BD-IPMN), defined as PCLs fulfilling any of multilocular formation, multiplicity, or MPD communication, were independent risk factors for PC. In 450 LRG observed for 5 years, 10-year PC incidence was higher in PCLs with our identified risk factors. There was no PC occurrence in PCLs not presumed BD-IPMN after 5-year observation. Conclusions Continuous surveillance is needed after 5-year observation, especially in LRG with our identified risk factors. For discontinuing surveillance, PCLs not presumed BD-IPMN at fifth year could be candidates.

Screening Strategy of Pancreatic Cancer in Patients with Diabetes Mellitus

“…DM is prevalent in patients with IPMN [ 26 , 27 ], and Capurso G et al reported an odds ratio (OR) of 1.79 (95% CI, 1.08–2.98) for IPMN in diabetic patients [ 26 ]. In addition, DM is reported to be associated with degree of dysplasia of IPMN [ 28 , 29 , 30 ]. Morales-Oyarvide V et al reported that the OR for high grade dysplasia (HGD) and invasive carcinoma among diabetic patients was 2.02 (95% CI, 1.02–4.01) and 2.05 (95% CI, 1.08–3.87), respectively [ 28 ].…”

International external validation of a stratification tool to identify branch‐duct intraductal papillary mucinous neoplasms at lowest risk of progression

“…These characteristics, either referred to as worrisome features (WFs) and high‐risk stigmata (HRS) in the international Fukuoka criteria, or as relative and absolute indications for surgery in the European guidelines, prompt for intensified surveillance or surgical resection 13,14 . In contrast, BD‐IPMNs without these features at diagnosis have a low risk of malignancy, 11,15,19,21–24 which decreases to less than 1% after several years of unremarkable follow‐up 15,22 …”

Establishment of organoids using residual samples from saline flushes during endoscopic ultrasound-guided fine-needle aspiration in patients with pancreatic cancer

“…Pancreatic cancer (PC) is one of the most aggressive malignant diseases, with a 5-year survival rate of 9 % 1 . Because it is difficult to detect PC at an early stage 2 3 , the majority of patients with it are diagnosed when the disease is unresectable and they primarily undergo chemotherapy 4 5 . Combination chemotherapy regimens have become the standard first-line chemotherapy in patients with unresectable PC.…”