A team of international researchers developed a profile identifying risk factors for malignancy progression in intraductal papillary mucinous neoplasms of the pancreas.
“The factors we found that increase risk of pancreatic cancer now allow us to separate patients as either low or high risk. High-risk patients can then be scanned and biopsied more frequently or can opt for surgery, but low-risk patients don’t need such surveillance,” Michael B. Wallace, MD, MPH, from Mayo Clinic in Jacksonville, Fla., said in a press release. “Pancreatic cancer is difficult to detect early — most patients are diagnosed at later stages when it’s 95% fatal — so we’re seeking ways to understand who is at risk.”
Wallace and colleagues performed a retrospective descriptive study of 1,126 patients with intraductal papillary mucinous neoplasm (IPMN; median age, 70.6 years; 61% female) identified in clinical databases from four centers in Europe and the United States spanning October 1997 to November 2013. Of these patients, 2.5% were diagnosed with high-grade dysplasia and 4.7% were diagnosed with IPMN-derived invasive carcinoma; their clinical and demographic variables were compared with the rest of the cohorts using multivariate logistic analysis.
Variables associated with cancer/high-grade dysplasia included smoking history (OR = 1.9; 95% CI, 1.1-3.1), BMI (OR = 1.1; 95% CI, 1-1.1), symptoms (OR = 3.4; 95% CI, 1.9-6), jaundice (OR = 0.1; 95% CI, 0-0.3) and steatorrhea (OR = 0.3; 95% CI, 0.1-0.8). There was no association between malignancy and cyst number or location, but strong associations with cyst size (P < .001), the presence and size of nodules (P < .01) and main duct involvement (P < .001) were observed.
“This study refines the current guidelines for treating these lesions, which are not very specific,” Wallace said in the release. “Hopefully, we can assure worried patients who have these common lesions that they are not at high risk.” – by Adam Leitenberger
Disclosures: Wallace reports he receives grant funding from Boston Scientific, Cosmo Pharmaceuticals and Olympus. Please see the full study for a list of all other authors’ relevant financial disclosures.