Factors Associated With the Risk of Progression of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms
Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic preneoplastic lesions, but their surveillance is not personalized. To investigate patient- and cyst-related factors associated with progression into worrisome features (WFs) or high-risk stigmata (HRS) categories o...
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| creator | Capurso, Gabriele Crippa, Stefano Vanella, Giuseppe Traini, Mariaemilia Zerboni, Giulia Zaccari, Piera Belfiori, Giulio Gentiluomo, Manuel Pessarelli, Tommaso Petrone, Maria Chiara Campa, Daniele Falconi, Massimo Arcidiacono, Paolo Giorgio |
| description | Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic preneoplastic lesions, but their surveillance is not personalized.
To investigate patient- and cyst-related factors associated with progression into worrisome features (WFs) or high-risk stigmata (HRS) categories of BD-IPMNs.
Cyst- and patient-related factors of consecutive BD-IPMNs without WFs or HRS in 540 patients diagnosed from 2009 to 2018 with at least 12 months' surveillance until February 28, 2020, were registered in a 2-center ambispective cohort study in Italy. In a subgroup, the ABO blood group was studied for the first time in this setting.
Cyst-related and patients-related factors and ABO blood group.
The study outcome was the appearance of WFs or HRS according to the 2017 International Association of Pancreatology guidelines. Survival probability was calculated using Kaplan-Meier curve and risk factors identified by Cox proportional hazards regression. ABO blood group was inferred through genotypes with DNA extraction.
Of 540 patients with BD-IPMNs (median age, 66 years [interquartile range, 58.5-72.0 years]; 337 women [62.4%]) undergoing surveillance for a median of 51.5 months (interquartile range, 28-84 months) for 2758 person-years, 130 patients (24.1%) experienced progression. Probability of progression was 3.7% at 1 year, 23.4% at 5 years, and 43.3% at 10 years; 15 patients (2.8%) underwent surgery, 7 patients (1.3%) had malignant histologic findings, and 3 patients (0.56%) died of pancreatic-associated disease. Initial cyst size greater than 15 mm (hazard ratio [HR], 2.05; 95% CI, 1.44-2.91), body mass index greater than 26.4 (HR, 1.72; 95% CI, 1.19-2.50), and heavy smoking (HR, 1.81; 95% CI, 1.14-2.86) were significant independent factors associated with progression risk. The AA blood genotype was also associated with progression risk (HR, 3.49; 95% CI, 1.04-11.71) compared with the OO genotype in the investigated subgroup.
This analysis of factors associated with progression of BD-IPMNs according to recent guidelines suggests that cyst size alone is not a reliable factor for estimation of progression risk; however, along with other readily available data, size is helpful for planning personalized surveillance of BD-IPMNs. |
| doi_str_mv | 10.1001/jamanetworkopen.2020.22933 |
| format | Article |
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To investigate patient- and cyst-related factors associated with progression into worrisome features (WFs) or high-risk stigmata (HRS) categories of BD-IPMNs.
Cyst- and patient-related factors of consecutive BD-IPMNs without WFs or HRS in 540 patients diagnosed from 2009 to 2018 with at least 12 months' surveillance until February 28, 2020, were registered in a 2-center ambispective cohort study in Italy. In a subgroup, the ABO blood group was studied for the first time in this setting.
Cyst-related and patients-related factors and ABO blood group.
The study outcome was the appearance of WFs or HRS according to the 2017 International Association of Pancreatology guidelines. Survival probability was calculated using Kaplan-Meier curve and risk factors identified by Cox proportional hazards regression. ABO blood group was inferred through genotypes with DNA extraction.
Of 540 patients with BD-IPMNs (median age, 66 years [interquartile range, 58.5-72.0 years]; 337 women [62.4%]) undergoing surveillance for a median of 51.5 months (interquartile range, 28-84 months) for 2758 person-years, 130 patients (24.1%) experienced progression. Probability of progression was 3.7% at 1 year, 23.4% at 5 years, and 43.3% at 10 years; 15 patients (2.8%) underwent surgery, 7 patients (1.3%) had malignant histologic findings, and 3 patients (0.56%) died of pancreatic-associated disease. Initial cyst size greater than 15 mm (hazard ratio [HR], 2.05; 95% CI, 1.44-2.91), body mass index greater than 26.4 (HR, 1.72; 95% CI, 1.19-2.50), and heavy smoking (HR, 1.81; 95% CI, 1.14-2.86) were significant independent factors associated with progression risk. The AA blood genotype was also associated with progression risk (HR, 3.49; 95% CI, 1.04-11.71) compared with the OO genotype in the investigated subgroup.
This analysis of factors associated with progression of BD-IPMNs according to recent guidelines suggests that cyst size alone is not a reliable factor for estimation of progression risk; however, along with other readily available data, size is helpful for planning personalized surveillance of BD-IPMNs.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2020.22933</identifier><identifier>PMID: 33252689</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Blood groups ; Carcinoma, Pancreatic Ductal - diagnosis ; Carcinoma, Pancreatic Ductal - pathology ; Cysts ; Disease Progression ; Female ; Gastroenterology and Hepatology ; Humans ; Male ; Middle Aged ; Neoplasms, Cystic, Mucinous, and Serous - diagnosis ; Neoplasms, Cystic, Mucinous, and Serous - pathology ; Online Only ; Original Investigation ; Pancreatic cancer ; Pancreatic Neoplasms - diagnosis ; Pancreatic Neoplasms - pathology ; Patients ; Precancerous Conditions - diagnosis ; Precancerous Conditions - pathology ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Surveillance ; Time Factors ; Tumors</subject><ispartof>JAMA network open, 2020-11, Vol.3 (11), p.e2022933-e2022933</ispartof><rights>2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2020 Capurso G et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a530t-a3760e715f2175f1f39c4cdcd96466c6fa9af45b45d4086cb1c59d9dab9359503</citedby><cites>FETCH-LOGICAL-a530t-a3760e715f2175f1f39c4cdcd96466c6fa9af45b45d4086cb1c59d9dab9359503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33252689$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Capurso, Gabriele</creatorcontrib><creatorcontrib>Crippa, Stefano</creatorcontrib><creatorcontrib>Vanella, Giuseppe</creatorcontrib><creatorcontrib>Traini, Mariaemilia</creatorcontrib><creatorcontrib>Zerboni, Giulia</creatorcontrib><creatorcontrib>Zaccari, Piera</creatorcontrib><creatorcontrib>Belfiori, Giulio</creatorcontrib><creatorcontrib>Gentiluomo, Manuel</creatorcontrib><creatorcontrib>Pessarelli, Tommaso</creatorcontrib><creatorcontrib>Petrone, Maria Chiara</creatorcontrib><creatorcontrib>Campa, Daniele</creatorcontrib><creatorcontrib>Falconi, Massimo</creatorcontrib><creatorcontrib>Arcidiacono, Paolo Giorgio</creatorcontrib><title>Factors Associated With the Risk of Progression of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic preneoplastic lesions, but their surveillance is not personalized.
To investigate patient- and cyst-related factors associated with progression into worrisome features (WFs) or high-risk stigmata (HRS) categories of BD-IPMNs.
Cyst- and patient-related factors of consecutive BD-IPMNs without WFs or HRS in 540 patients diagnosed from 2009 to 2018 with at least 12 months' surveillance until February 28, 2020, were registered in a 2-center ambispective cohort study in Italy. In a subgroup, the ABO blood group was studied for the first time in this setting.
Cyst-related and patients-related factors and ABO blood group.
The study outcome was the appearance of WFs or HRS according to the 2017 International Association of Pancreatology guidelines. Survival probability was calculated using Kaplan-Meier curve and risk factors identified by Cox proportional hazards regression. ABO blood group was inferred through genotypes with DNA extraction.
Of 540 patients with BD-IPMNs (median age, 66 years [interquartile range, 58.5-72.0 years]; 337 women [62.4%]) undergoing surveillance for a median of 51.5 months (interquartile range, 28-84 months) for 2758 person-years, 130 patients (24.1%) experienced progression. Probability of progression was 3.7% at 1 year, 23.4% at 5 years, and 43.3% at 10 years; 15 patients (2.8%) underwent surgery, 7 patients (1.3%) had malignant histologic findings, and 3 patients (0.56%) died of pancreatic-associated disease. Initial cyst size greater than 15 mm (hazard ratio [HR], 2.05; 95% CI, 1.44-2.91), body mass index greater than 26.4 (HR, 1.72; 95% CI, 1.19-2.50), and heavy smoking (HR, 1.81; 95% CI, 1.14-2.86) were significant independent factors associated with progression risk. The AA blood genotype was also associated with progression risk (HR, 3.49; 95% CI, 1.04-11.71) compared with the OO genotype in the investigated subgroup.
This analysis of factors associated with progression of BD-IPMNs according to recent guidelines suggests that cyst size alone is not a reliable factor for estimation of progression risk; however, along with other readily available data, size is helpful for planning personalized surveillance of BD-IPMNs.</description><subject>Aged</subject><subject>Blood groups</subject><subject>Carcinoma, Pancreatic Ductal - diagnosis</subject><subject>Carcinoma, Pancreatic Ductal - pathology</subject><subject>Cysts</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasms, Cystic, Mucinous, and Serous - diagnosis</subject><subject>Neoplasms, Cystic, Mucinous, and Serous - pathology</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - diagnosis</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Patients</subject><subject>Precancerous Conditions - diagnosis</subject><subject>Precancerous Conditions - pathology</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surveillance</subject><subject>Time Factors</subject><subject>Tumors</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdUV1v1DAQtBCIVqV_AVnwwksOf8R2zANSKRQqHVAhEI_WnuP0fE3sYDtU_HuSa6lKn3ZXOzs7o0HoBSUrSgh9vYMBgivXMV3F0YUVI4ysGNOcP0KHTKi64g0Rj-_1B-g45x0hM5ByLcVTdMA5E0w2-hCNZ2BLTBmf5Byth-Ja_NOXLS5bh7_5fIVjhy9SvEwuZx_DMq7jdbVfvUsQ7LZ6P9mCz0NJ0M4d9PgCRt_3kP7gz5P1IU4Zf3Fx7CEP-Rl60kGf3fFtPUI_zj58P_1Urb9-PD89WVcgOCkVcCWJU1R0jCrR0Y5rW9vWtlrWUlrZgYauFptatDVppN1QK3SrW9hoLrQg_Ai9veEdp83gWusWfb0Zkx9mYSaCN_9vgt-ay_jbKEWE0GwmeHVLkOKvyeViBp-tm30FNzsyrJZCiUY3y6-XD6C7OKUw2zNMStU0XO1Rb25QNsWck-vuxFBilmzNg2zNkq3ZZzsfP79v5-70X5L8L5qXpx8</recordid><startdate>20201102</startdate><enddate>20201102</enddate><creator>Capurso, Gabriele</creator><creator>Crippa, Stefano</creator><creator>Vanella, Giuseppe</creator><creator>Traini, Mariaemilia</creator><creator>Zerboni, Giulia</creator><creator>Zaccari, Piera</creator><creator>Belfiori, Giulio</creator><creator>Gentiluomo, Manuel</creator><creator>Pessarelli, Tommaso</creator><creator>Petrone, Maria Chiara</creator><creator>Campa, Daniele</creator><creator>Falconi, Massimo</creator><creator>Arcidiacono, Paolo Giorgio</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20201102</creationdate><title>Factors Associated With the Risk of Progression of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms</title><author>Capurso, Gabriele ; Crippa, Stefano ; Vanella, Giuseppe ; Traini, Mariaemilia ; Zerboni, Giulia ; Zaccari, Piera ; Belfiori, Giulio ; Gentiluomo, Manuel ; Pessarelli, Tommaso ; Petrone, Maria Chiara ; Campa, Daniele ; Falconi, Massimo ; Arcidiacono, Paolo Giorgio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a530t-a3760e715f2175f1f39c4cdcd96466c6fa9af45b45d4086cb1c59d9dab9359503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Blood groups</topic><topic>Carcinoma, Pancreatic Ductal - diagnosis</topic><topic>Carcinoma, Pancreatic Ductal - pathology</topic><topic>Cysts</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasms, Cystic, Mucinous, and Serous - diagnosis</topic><topic>Neoplasms, Cystic, Mucinous, and Serous - pathology</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - diagnosis</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Patients</topic><topic>Precancerous Conditions - diagnosis</topic><topic>Precancerous Conditions - pathology</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surveillance</topic><topic>Time Factors</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Capurso, Gabriele</creatorcontrib><creatorcontrib>Crippa, Stefano</creatorcontrib><creatorcontrib>Vanella, Giuseppe</creatorcontrib><creatorcontrib>Traini, Mariaemilia</creatorcontrib><creatorcontrib>Zerboni, Giulia</creatorcontrib><creatorcontrib>Zaccari, Piera</creatorcontrib><creatorcontrib>Belfiori, Giulio</creatorcontrib><creatorcontrib>Gentiluomo, Manuel</creatorcontrib><creatorcontrib>Pessarelli, Tommaso</creatorcontrib><creatorcontrib>Petrone, Maria Chiara</creatorcontrib><creatorcontrib>Campa, Daniele</creatorcontrib><creatorcontrib>Falconi, Massimo</creatorcontrib><creatorcontrib>Arcidiacono, Paolo Giorgio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Capurso, Gabriele</au><au>Crippa, Stefano</au><au>Vanella, Giuseppe</au><au>Traini, Mariaemilia</au><au>Zerboni, Giulia</au><au>Zaccari, Piera</au><au>Belfiori, Giulio</au><au>Gentiluomo, Manuel</au><au>Pessarelli, Tommaso</au><au>Petrone, Maria Chiara</au><au>Campa, Daniele</au><au>Falconi, Massimo</au><au>Arcidiacono, Paolo Giorgio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors Associated With the Risk of Progression of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2020-11-02</date><risdate>2020</risdate><volume>3</volume><issue>11</issue><spage>e2022933</spage><epage>e2022933</epage><pages>e2022933-e2022933</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic preneoplastic lesions, but their surveillance is not personalized.
To investigate patient- and cyst-related factors associated with progression into worrisome features (WFs) or high-risk stigmata (HRS) categories of BD-IPMNs.
Cyst- and patient-related factors of consecutive BD-IPMNs without WFs or HRS in 540 patients diagnosed from 2009 to 2018 with at least 12 months' surveillance until February 28, 2020, were registered in a 2-center ambispective cohort study in Italy. In a subgroup, the ABO blood group was studied for the first time in this setting.
Cyst-related and patients-related factors and ABO blood group.
The study outcome was the appearance of WFs or HRS according to the 2017 International Association of Pancreatology guidelines. Survival probability was calculated using Kaplan-Meier curve and risk factors identified by Cox proportional hazards regression. ABO blood group was inferred through genotypes with DNA extraction.
Of 540 patients with BD-IPMNs (median age, 66 years [interquartile range, 58.5-72.0 years]; 337 women [62.4%]) undergoing surveillance for a median of 51.5 months (interquartile range, 28-84 months) for 2758 person-years, 130 patients (24.1%) experienced progression. Probability of progression was 3.7% at 1 year, 23.4% at 5 years, and 43.3% at 10 years; 15 patients (2.8%) underwent surgery, 7 patients (1.3%) had malignant histologic findings, and 3 patients (0.56%) died of pancreatic-associated disease. Initial cyst size greater than 15 mm (hazard ratio [HR], 2.05; 95% CI, 1.44-2.91), body mass index greater than 26.4 (HR, 1.72; 95% CI, 1.19-2.50), and heavy smoking (HR, 1.81; 95% CI, 1.14-2.86) were significant independent factors associated with progression risk. The AA blood genotype was also associated with progression risk (HR, 3.49; 95% CI, 1.04-11.71) compared with the OO genotype in the investigated subgroup.
This analysis of factors associated with progression of BD-IPMNs according to recent guidelines suggests that cyst size alone is not a reliable factor for estimation of progression risk; however, along with other readily available data, size is helpful for planning personalized surveillance of BD-IPMNs.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>33252689</pmid><doi>10.1001/jamanetworkopen.2020.22933</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Blood groups Carcinoma, Pancreatic Ductal - diagnosis Carcinoma, Pancreatic Ductal - pathology Cysts Disease Progression Female Gastroenterology and Hepatology Humans Male Middle Aged Neoplasms, Cystic, Mucinous, and Serous - diagnosis Neoplasms, Cystic, Mucinous, and Serous - pathology Online Only Original Investigation Pancreatic cancer Pancreatic Neoplasms - diagnosis Pancreatic Neoplasms - pathology Patients Precancerous Conditions - diagnosis Precancerous Conditions - pathology Prospective Studies Retrospective Studies Risk Factors Surveillance Time Factors Tumors |
| title | Factors Associated With the Risk of Progression of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms |
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