New onset diabetes predicts progression of low risk pancreatic mucinous cysts

Schweber, Adam B.; Brooks, Christian; Agarunov, Emil; Sethi, Amrita; Poneros, John M.; Schrope, Beth; Kluger, Michael D.; Chabot, John A.; Gonda, Tamas A.

doi:10.1016/j.pan.2020.09.015

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…12,21,22,[42][43][44] Furthermore, the percentages of patients with a history of diabetes (25%) and NODM (11%) are similar to the equivalent percentages observed in prior studies of mucinous cysts. 12,21,22,26,45 Finally, our cumulative progression rate to PC of 2.1% at 5 years is consistent with previous progression results among patients with low-risk mucinous and premalignant cysts. 46,47 Multivariable Cox modeling showed that those cyst patients who developed NODM progressed to PC at nearly 3 times the rate of patients without a history of diabetes.…”

Section: Discussionsupporting

confidence: 79%

“…However, there has been limited study of the association of NODM with malignant transformation in patients with pancreatic cysts, a group of patients known to possess a substantially higher risk of developing PC. Prior studies of the association of NODM with PC in cyst patients have relied on extremely small cohorts and cross-sectional surgical series of high-risk and symptomatic patients 21–28 . Accordingly, while the European guidelines for the management of IPMNs recently introduced NODM as a relative indication for surgery, the evidence was considered low quality and these guidelines did not specify when, how, and who to screen for NODM.…”

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confidence: 99%

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New-Onset Diabetes Is a Potential Marker for the Malignant Transformation of Pancreatic Cysts

et al. 2022

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ObjectivesNew-onset diabetes mellitus has been shown to be associated with pancreatic cancer (PC) in the general population. Our objective was to leverage real-world data to assess the association of new-onset diabetes (NODM) with malignant transformation in a large longitudinal cohort of pancreatic cyst patients.MethodsA retrospective longitudinal cohort study was conducted using IBM's MarketScan claims databases from 2009 to 2017. From 200 million database subjects, we selected patients with newly diagnosed cysts without prior pancreatic pathology.ResultsOf the 137,970 patients with a pancreatic cyst, 14,279 had a new diagnosis. Median follow-up was 41.6 months. Patients with NODM progressed to PC at nearly 3 times the rate of patients without a diabetes history (hazard ratio, 2.80; 95% confidence interval, 2.05–3.83) and at a significantly higher rate than patients with preexisting diabetes (hazard ratio, 1.59; 95% confidence interval, 1.14–2.21). The mean interval between NODM and cancer diagnosis was 7.5 months.ConclusionsCyst patients who developed NODM progressed to PC at 3 times the rate of nondiabetics and at a greater rate than preexisting diabetics. The diagnosis of NODM preceded cancer detection by several months. These results support the inclusion of diabetes mellitus screening in cyst surveillance algorithms.

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Section: Discussionsupporting

confidence: 79%

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confidence: 99%

New-Onset Diabetes Is a Potential Marker for the Malignant Transformation of Pancreatic Cysts

et al. 2022

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“…In another study, using a prospectively maintained cohort of 442 patients with a suspected mucinous cyst without worrisome features or high-risk stigmata, the development of new-onset diabetes mellitus was strongly associated with progression to high-risk stigmata (HR = 11.6; 95% CI, 3.5-57.7%), but was not associated with the development of worrisome features after controlling for other risk factors. This is of importance in patients with larger cysts (2-3 cm), as they were found to have a 5-year adjusted cumulative risk of progression to developing high-risk stigmata of 53.5% (95% CI, 19.6%-89.9%) compared to only 7.5% (95% CI, 1.6%-15.2%) in patients without new-onset diabetes [66].…”

Section: Predicting Malignant Transformation In Ipmn 211 Symptoms and Risk Factorsmentioning

confidence: 99%

A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

Keane

Afghani

2021

JCM

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Pancreatic cystic lesions are an increasingly common clinical finding. They represent a heterogeneous group of lesions that include two of the three known precursors of pancreatic cancer, intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Given that approximately 8% of pancreatic cancers arise from these lesions, careful surveillance and timely surgery offers an opportunity for early curative resection in a disease with a dismal prognosis. This review summarizes the current evidence and guidelines for the diagnosis and management of IPMN/MCN. Current pre-operative diagnostic tests in pancreatic cysts are imperfect and a proportion of patients continue to undergo unnecessary surgical resection annually. Balancing cancer prevention while preventing surgical overtreatment, continues to be challenging when managing pancreatic cysts. Cyst fluid molecular markers, such as KRAS, GNAS, VHL, PIK3CA, SMAD4 and TP53, as well as emerging endoscopic technologies such as needle-based confocal laser endomicroscopy and through the needle microbiopsy forceps demonstrate improved diagnostic accuracy. Differences in management and areas of uncertainty between the guidelines are also discussed, including indications for surgery, surveillance protocols and if and when surveillance can be discontinued.

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“…Other studies have suggested that the overall risk of cyst conversion with low-risk features, to high-risk stigmata for malignancy, varies between 0.8% and 15%, depending on other variable factors. 6,7 Added to this is the fact that cirrhotic patients have more than 2-fold increased risk of nonhepatocellular malignancies, compared with the general population. 8 The possibility of progression of pPCLs becomes more of a concern with chronic immunosuppression.…”

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confidence: 99%

“…Using a large cohort of veterans, Munigala et al 5 have suggested that the overall risk of pancreatic cancer is estimated to be 19.6 times greater in patients with pancreatic cysts compared with those without pancreatic cysts. Other studies have suggested that the overall risk of cyst conversion with low-risk features, to high-risk stigmata for malignancy, varies between 0.8% and 15%, depending on other variable factors 6,7 …”

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confidence: 99%

Current Evidence in the Management of Premalignant Cystic Lesions of the Pancreas in Patients Undergoing Liver Transplantation

Babu

Shapiro

2022

Pancreas

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Incidental premalignant pancreatic cystic lesions (pPCLs) are increasingly being detected in patients undergoing orthotopic liver transplantation (OLT). The impact of chronic immunosuppression upon pPCLs may elevate risk of progression to pancreatic cancer. This systematic review assesses prevalence, outcome, and management of pPCLs in patients undergoing OLT. Systematic literature searches were performed in accordance with Cochrane review guidelines. Data on 658 patients were identified from 13 articles. Median age was 59 years with a prevalence of 6.2%. Most studies focused on branch-duct intraductal papillary mucinous neoplasms. Average cyst size at diagnosis was 10.3 mm. Six patients (0.9%) underwent pancreatic resection, post-OLT, for suspected “worrisome features” on imaging. One death was due to pancreatic-related cancer, post-OLT. Based on the review, the authors suggest the following: (1) patients with pPCLs undergoing OLT, without “worrisome features,” should be followed conservatively; (2) presence of pPCLs alone should not preclude eligibility for OLT, nor should chronic immunosuppression be altered; (3) follow-up should parallel standard approach applied in immunocompetent patients, as development of “worrisome features” of cancer is rare and does not appear to be hastened by immunosuppression; (4) resection is recommended for surgically fit patients without portal hypertension that develop “worrisome features.”

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New onset diabetes predicts progression of low risk pancreatic mucinous cysts

Cited by 9 publications

References 29 publications

New-Onset Diabetes Is a Potential Marker for the Malignant Transformation of Pancreatic Cysts

New-Onset Diabetes Is a Potential Marker for the Malignant Transformation of Pancreatic Cysts

A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

Current Evidence in the Management of Premalignant Cystic Lesions of the Pancreas in Patients Undergoing Liver Transplantation

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