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

• Published in: Alimentary pharmacology & therapeutics Vol. 50; no. 7; pp. 789 - 799
• Main Authors: Overbeek, Kasper A., Alblas, Maaike, Gausman, Valerie, Kandel, Pujan, Schweber, Adam B., Brooks, Christian, Van Riet, Priscilla A., Wallace, Michael B., Gonda, Tamas A., Cahen, Djuna L., Bruno, Marco J.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2019; John Wiley and Sons Inc
• Subjects: Aged; Carcinoma, Pancreatic Ductal - pathology; Cohort Studies; Cysts; Disease Progression; Female; Humans; Identifying Pancreatic Intraductal Papillary Mucinous Neoplasms at Low Risk of Progression; Male; Malignancy; Middle Aged; Original; Pancreas; Pancreas - pathology; Pancreatic Cyst - pathology; Pancreatic Neoplasms - pathology; Pancreatitis; Prediction models; Prospective Studies; Regression analysis; Risk; Surveillance; Tumors
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.15440

Summary 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.