Progression of pancreatic cystic lesions without any risk features is associated with initial cyst size and obesity.
Guideline
Obesity
Pancreatic cyst
Pancreatic neoplasms
Population
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
26
07
2019
revised:
07
11
2019
accepted:
19
11
2019
pubmed:
24
11
2019
medline:
8
10
2020
entrez:
24
11
2019
Statut:
ppublish
Résumé
The clinical significance of incidental pancreatic cystic lesions (PCLs) remains unclear in those that are not accompanied by worrisome features or high-risk stigmata. We aimed to investigate the natural course of PCLs without any risk features and examine the clinical factors associated with their progression. We conducted a retrospective cohort study of 427 patients with PCLs, which were incidentally detected by computed tomography between January 2003 and December 2012. Progression of PCLs without any risk features and the clinical factors associated with their progression were investigated. The length of time to significant growth was also evaluated. Ninety-four (22.0%) of the 427 patients had asymptomatic PCLs that showed significant growth after a median surveillance period of 5.3 years; approximately 27.7% of the patients showed significant size changes in the first 5 years, while the remaining 72.3% showed significant changes after 5 years. The cumulative rate of patients with significant growth was associated with initial cyst size and high body mass index. In the growth group, additional treatments were required for 12 patients, one of whom developed malignancy. Four patients in the stable group underwent additional treatment and showed no malignant change. One-fifth of the asymptomatic PCLs significantly increased in size after a long-term follow-up period, which was associated with initial cyst size and obesity. The size of PCLs mostly increased after 5 years; although the malignancy risk of PCLs was low, it was still a concern.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
The clinical significance of incidental pancreatic cystic lesions (PCLs) remains unclear in those that are not accompanied by worrisome features or high-risk stigmata. We aimed to investigate the natural course of PCLs without any risk features and examine the clinical factors associated with their progression.
METHODS
METHODS
We conducted a retrospective cohort study of 427 patients with PCLs, which were incidentally detected by computed tomography between January 2003 and December 2012. Progression of PCLs without any risk features and the clinical factors associated with their progression were investigated. The length of time to significant growth was also evaluated.
RESULTS
RESULTS
Ninety-four (22.0%) of the 427 patients had asymptomatic PCLs that showed significant growth after a median surveillance period of 5.3 years; approximately 27.7% of the patients showed significant size changes in the first 5 years, while the remaining 72.3% showed significant changes after 5 years. The cumulative rate of patients with significant growth was associated with initial cyst size and high body mass index. In the growth group, additional treatments were required for 12 patients, one of whom developed malignancy. Four patients in the stable group underwent additional treatment and showed no malignant change.
CONCLUSIONS
CONCLUSIONS
One-fifth of the asymptomatic PCLs significantly increased in size after a long-term follow-up period, which was associated with initial cyst size and obesity. The size of PCLs mostly increased after 5 years; although the malignancy risk of PCLs was low, it was still a concern.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
877-884Informations de copyright
© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Fernandez-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch. Surg. 2003; 138: 427-423 discussion 433-424.
Parra-Herran CE, Garcia MT, Herrera L, Bejarano PA. Cystic lesions of the pancreas: clinical and pathologic review of cases in a five year period. JOP 2010; 11: 358-364.
Garcea G, Ong SL, Rajesh A et al. Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology 2008; 8: 236-251.
Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am. J. Gastroenterol. 2010; 105: 2079-2084.
Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW. Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: large-scale, single-center cohort study. Medicine (Baltimore) 2016; 95: e5535.
Kromrey ML, Bulow R, Hubner J et al. Prospective study on the incidence, prevalence and 5-year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut 2018; 67: 138-145.
Sun L, Wang Y, Jiang F, Qian W, Shao C, Jin Z. Prevalence of pancreatic cystic lesions detected by magnetic resonance imaging in the Chinese population. J. Gastroenterol. Hepatol. 2019; 34: 1656-1662.
Kwong WT, Hunt GC, Fehmi SM et al. Low rates of malignancy and mortality in asymptomatic patients with suspected neoplastic pancreatic cysts beyond 5 years of surveillance. Clin. Gastroenterol. Hepatol. 2016; 14: 865-871.
Pergolini I, Sahora K, Ferrone CR et al. Long-term risk of pancreatic malignancy in patients with branch duct intraductal papillary mucinous neoplasm in a referral center. Gastroenterology 2017; 153: 1284-1294 e1281.
Han Y, Lee H, Kang JS et al. Progression of pancreatic branch duct intraductal papillary mucinous neoplasm associates with cyst size. Gastroenterology 2018; 154: 576-584.
Petrone MC, Magnoni P, Pergolini I et al. Long-term follow-up of low-risk branch-duct IPMNs of the pancreas: is main pancreatic duct dilatation the most worrisome feature? Clin. Transl. Gastroenterol. 2018; 9: 158.
de Pretis N, Mukewar S, Aryal-Khanal A, Bi Y, Takahashi N, Chari S. Pancreatic cysts: diagnostic accuracy and risk of inappropriate resections. Pancreatology 2017; 17: 267-272.
Tanaka M, Fernandez-Del Castillo C, Kamisawa T et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17: 738-753.
European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789-804.
Fernandez-Del Castillo C, Tanaka M. Management of pancreatic cysts: the evidence is not here yet. Gastroenterology 2015; 148: 685-687.
Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American Gastroenterological Association Institute Guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819-822 quize812-813.
Megibow AJ, Baker ME, Morgan DE et al. Management of incidental pancreatic cysts: a white paper of the ACR Incidental Findings Committee. J. Am. Coll. Radiol. 2017; 14: 911-923.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157-163.
American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care 2018; 41: S13-s27.
Zerboni G, Signoretti M, Crippa S, Falconi M, Arcidiacono PG, Capurso G. Systematic review and meta-analysis: prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology 2019; 19: 2-9.
Yoen H, Kim JH, Lee DH, Ahn SJ, Yoon JH, Han JK. Fate of small pancreatic cysts (<3 cm) after long-term follow-up: analysis of significant radiologic characteristics and proposal of follow-up strategies. Eur. Radiol. 2017; 27: 2591-2599.
Morris-Stiff G, Falk GA, Chalikonda S, Walsh RM. Natural history of asymptomatic pancreatic cystic neoplasms. HPB (Oxford) 2013; 15: 175-181.
Nougaret S, Reinhold C, Chong J et al. Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur. Radiol. 2014; 24: 1020-1029.
Scheiman JM, Hwang JH, Moayyedi P. American Gastroenterological Association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 824-848 e822.
Crippa S, Pezzilli R, Bissolati M et al. Active surveillance beyond 5 years is required for presumed branch-duct intraductal papillary mucinous neoplasms undergoing non-operative management. Am. J. Gastroenterol. 2017; 112: 1153-1161.
Mizuno S, Isayama H, Nakai Y et al. Prevalence of pancreatic cystic lesions is associated with diabetes mellitus and obesity: an analysis of 5296 individuals who underwent a preventive medical examination. Pancreas 2017; 46: 801-805.
Mizuno S, Nakai Y, Isayama H et al. Visceral adiposity and high adiponectin levels are associated with the prevalence of pancreatic cystic lesions. Int. J. Obes. (Lond) 2019; 43: 169-175.