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

• DOI: 10.1111/apt.15440
• Publication Date: 2019-08-20T01:05:11Z
• Authors: Kasper A. Overbeek; Maaike Alblas; Valerie Gausman; Pujan Kandel; Adam B. Schweber; Christian Brooks; Priscilla A. Van ...; Michael B. Wallace; Tamas A. Gonda; Djuna L. Cahen; Marco J. Bruno
• Keywords: Male; Risk; EMC MM-04-20-01; EMC NIHES-02-65-01; Middle Aged; 3. Good health; Cohort Studies; Pancreatic Neoplasms; 03 medical and health sciences; 0302 clinical medicine; EMC MM-03-49-01; Disease Progression; Humans; Female; Prospective Studies; Pancreatic Cyst; Identifying Pancreatic Intraductal Papillary Mucinous Neoplasms at Low Risk of Progression; Pancreas; Aged; Carcinoma, Pancreatic Ductal

Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long-term surveillance is low-yield for individuals.To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high-risk stigmata.We combined prospectively maintained cyst databases three academic institutions. Patients were included if they had presumed side-branch IPMN, without stigmata baseline (as defined by the 2012 international Fukuoka guidelines), and followed ≥ 12 months. The endpoint was development one more during follow-up. We created multivariable prediction model using Cox-proportional logistic regression analysis performed an internal-external validation.875 patients included. After mean follow-up 50 months (range 12-157), 116 (13%) developed stigmata. final size (HR 1.12, 95% CI 1.09-1.15), multifocality 1.49, 1.01-2.18), ever having smoked 1.40, 0.95-2.04), history acute pancreatitis 2.07, 1.21-3.55), extrapancreatic malignancy 1.34, 0.91-1.97). validation, good discriminative ability (C-statistic 0.72 in Mayo cohort, 0.71 Columbia 0.64 Erasmus cohort).In side branch baseline, Dutch-American Risk stratification Tool (DART-1) successfully identifies lesions low