Study finds lower risk of pancreatic cancer if pancreatic cysts remain stable for five years
USA: A recent study published inClinical Gastroenterology and Hepatologyhas found alower incidence of advanced neoplasia during extended surveillance in low-risk, stable-sized branch duct intraductal papillary mucinous neoplasms (BD-IPMNs).
"However, the survival benefit of surveillance among this population warrants further research through high-quality studies before recommending surveillance cessation with certainty," the researchers wrote.
Low-risk branch duct intraductal papillary mucinous neoplasms (IPMN) are the most common precancerous form of mucinous pancreatic cysts and, once identified, require regular surveillance imaging. But consensus is still forming around how long that watchful period should last. In the study, Yale Cancer Center researchers at Yale School of Medicine question the health benefit of extended surveillance for patients whose cyst has not changed size for at least five years and had no worrisome features.
"Pancreatic cysts are extremely common and often require regular imaging surveillance due to their variable risk of pancreatic cancer,” said senior author Dr. James Farrell, professor of medicine and surgery at Yale School of Medicine and director of the Yale Center for Pancreatic Diseases. “Controversy exists with current guidelines about which patients should consider stopping surveillance. This current study highlights the persistent risk of malignancy even after five or ten years of surveillance.”
In a systematic review of 41 IPMN surveillance studies, researchers compared the incidence of worrisome features and high-risk stigmata (WF/HRS) as well as advanced neoplasia (including pancreatic cancer) during the initial surveillance period (during the first five years after initial observation). They extended the surveillance period (after five years).
Researchers found the risk of WF/HRS rose from 2.2% in initial surveillance to 2.9% patient-years in extended surveillance. In comparison, the risk of advanced neoplasia rose from 0.6% to 1.0% in patient-years between the initial and extended periods. However, among patients whose cyst had five years of size stability, extended surveillance showed a lower 1.9% patient-years risk of WF/HRS and a 0.2% patient-years risk of advanced neoplasia.
In certain patients for whom cyst size remained stable for five years or more, extended surveillance may not offer a worthwhile survival benefit. Still, researchers said more high-quality studies are needed before surveillance cessation can be recommended.
“A greater understanding of the biology and natural history of progression of pancreatic cysts is needed to improve our surveillance strategies, to make more informed decisions about which patients to follow more closely, and about which patients we can decrease surveillance,” said Farrell.
References:- Ankit Chhoda 1, Sidhant Singh 2, Amar H. Sheth 3, Alyssa A. Grimshaw 4, Craig G. Gunderson 5, Prabin Sharma 6, John W. Kunstman 7, Anup Sharma 8, Nita Ahuja 8, Tamas A. Gonda 9, James J. Farrell 1
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