| Institution: | 1. Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, NY, USA;2. Pancreas Center, Division of Surgery, Columbia University Irving Medical Center, NY, USA;3. Larner College of Medicine at the University of Vermont, Burlington, VT, USA;4. Division of Gastroenterology and Hepatology, New York University, New York, NY;1. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;2. Dept of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland;1. Shikoku Cancer Center, Japan;2. Sasebo Kyosai Hospital, Japan;1. Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan;2. Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan;3. Department of Gastroenterology and Hepatology, Nissay Hospital, Japan |
| Abstract: | BackgroundPatients with low-risk lesions require ongoing surveillance since the rate of progression to pancreatic cancer (PC), while small, is much greater than in the general population. Our objective was to study the relationship between new onset diabetes (NODM) and progression in patients with low risk mucinous cysts.MethodsWe evaluated a prospectively maintained cohort of 442 patients with a suspected mucinous cyst without worrisome features (WF) or high-risk stigmata (HRS). Multivariable Cox models were developed for progression to WF and HRS, with diabetes status formulated as both time independent and dependent covariates. The adjusted cumulative risk of progression was calculated using the corrected group prognosis method.ResultsThe 5-year cumulative progression rates to WFs and HRS were 12.8 and 3.6%, respectively. After controlling for other risk factors, the development of NODM was strongly associated with progression to HRS (HR = 11.6; 95%CI, 3.5–57.7%), but not WF. Among patients with the smallest cysts (<10 mm) at baseline, those who developed NODM had a 5-year adjusted cumulative risk of progression to HRS of 8.6% (95%CI, 0.0%–20.2%), compared to only 0.8% (95%CI, 0.0%–2.3%) for patients without NODM. Among patients with the largest cysts (20–29 mm), those who developed NODM during surveillance had a 5-year adjusted cumulative risk of progression of 53.5% (95%CI, 19.6%–89.9%) compared to only 7.5% (95%CI, 1.6%–15.2%) for patients without NODM.ConclusionNew onset diabetes may predict progression in patients with low risk mucinous cysts. Pending validation with large-scale studies, these findings support regular diabetes screening among patients surveilled for suspected IPMNs or MCNs. |
