The Revised Kyoto Criteria and Risk of Malignancy Among Patients With Intraductal Papillary Mucinous Neoplasms.

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  • Additional Information
    • Source:
      Publisher: W.B. Saunders for the American Gastroenterological Association Country of Publication: United States NLM ID: 101160775 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1542-7714 (Electronic) Linking ISSN: 15423565 NLM ISO Abbreviation: Clin Gastroenterol Hepatol Subsets: MEDLINE
    • Publication Information:
      Original Publication: Philadelphia, PA : W.B. Saunders for the American Gastroenterological Association, 2003-
    • Subject Terms:
      Pancreatic Neoplasms*/epidemiology ; Pancreatic Neoplasms*/pathology ; Pancreatic Neoplasms*/diagnosis ; Pancreatic Intraductal Neoplasms*/pathology ; Pancreatic Intraductal Neoplasms*/epidemiology; Humans ; Female ; Male ; Aged ; Middle Aged ; Risk Assessment/methods ; Japan/epidemiology ; Incidence ; Risk Factors ; Carcinoma, Pancreatic Ductal/epidemiology ; Carcinoma, Pancreatic Ductal/pathology ; Carcinoma, Pancreatic Ductal/diagnosis ; Adenocarcinoma, Mucinous/pathology ; Adenocarcinoma, Mucinous/epidemiology ; Retrospective Studies ; Aged, 80 and over ; Practice Guidelines as Topic ; Adult
    • Abstract:
      Background & Aims: The revised Kyoto guidelines have a new catalog of high-risk stigmata and worrisome features for the risk stratification of intraductal papillary mucinous neoplasms (IPMNs). We aimed to validate the stratification system in terms of short- and long-term risks of pancreatic carcinoma.
      Methods: We included 3336 patients diagnosed with IPMNs in 2000-2021 and examined short-term (≤6 months) and long-term risks of pancreatic carcinoma diagnosis. We used the multivariable competing-risks proportional hazards regression model to calculate subdistribution hazard ratios for long-term incidence of pancreatic carcinoma with adjustment for potential confounders.
      Results: In short-term analyses, pancreatic carcinomas were prevalent predominantly in IPMNs with high-risk stigmata (49% vs 1.3% and 0.05% in IPMNs with worrisome features and no risk factors, respectively). In long-term analyses of worrisome features, the main pancreatic duct diameter of 5-9.9 mm, acute pancreatitis, and IPMN growth rate of 2.5 mm/y were associated with a high incidence with multivariable subdistribution hazard ratios of 3.46 (95% confidence interval [CI], 2.04-5.89), 5.65 (95% CI, 1.86-17.2), and 3.83 (95% CI, 2.14-6.86), respectively. An increasing number of worrisome features at baseline was associated with a higher prevalence and incidence of pancreatic carcinoma (P trend < .001). Patients with 1, 2, and 3-4 worrisome features had multivariable subdistribution hazard ratios for pancreatic cancer incidence of 1.43 (95% CI, 0.93-2.19), 2.17 (95% CI, 1.17-4.05), and 10.1 (95% CI, 4.20-24.5), respectively (vs no positive feature).
      Conclusions: The revised Kyoto criteria stratify IPMN patients well in terms of the short- and long-term risks of pancreatic carcinoma diagnosis, potentially informing personalized patient management.
      (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Carcinogenesis; Cohort Studies; Pancreatic Neoplasms; Risk Factors
    • Publication Date:
      Date Created: 20240616 Date Completed: 20241124 Latest Revision: 20241124
    • Publication Date:
      20241126
    • Accession Number:
      10.1016/j.cgh.2024.05.043
    • Accession Number:
      38880125