Small and Stable Pancreatic Cysts Are Reassuring During Surveillance: Results From the PACYFIC Trial.
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Levink Iris J M, Sprij Marloes L J A, Koopmann Brechtje D M, Meziani Jihane, Jaarsma Sanne, van Riet Priscilla A, Overbeek Kasper A, Gorris Myrte, Voermans Rogier P, van Hooft Jeanin E, Casadei Riccardo, Di Marco Mariacristina, Wallace Michael B, Hoogenboom Sanne A, Azopardi Neville, Ahola Reea, Polkowski Marcin, Honkoop Pieter, Carrara Silvia, Schoon Erik J, Venneman Niels G, van der Waaij Laurens A, van Berkel Anne-Marie, Rossi Gemma, Bergmann Jilling F, Pando Elizabeth, Beyer Georg, Schwartz Matthijs P, van Vilsteren Frederike G I, Hoge Chantal, Smits Marianne E, Quispel Rutger, van Soest Ellert J, Vos Patrick M, Verdonk Robert C, Steinhauser Toon, Kouw Eva, Tan Adriaan C I T L, Czako Laszlo, Bruno Marco J, Cahen Djuna L, PACYFIC‐Study Work Group
Аннотация
METHODS: This nested PACYFIC-study is a collaboration among 44 centers in Europe and Northern-America, and investigates the risk of HGD and PC for different cyst sizes and growth rates in participants without baseline worrisome features (WF) or high-risk stigmata (HRS).
RESULTS: Of the 2369 PACYFIC participants, 975 met the inclusion criteria, with a mean age of 67 years (SD 13) and 65% being female. Of these, 438 individuals (45%) had a baseline small cyst size (< 15 mm), and 885 (91%) individuals had a slow growth rate (< 2.5 mm/year). During a median follow-up of 45 months (IQR 27), 20 individuals (2.1%) developed HGD, or PC. Individuals with small cysts had a 1.5-fold lower risk of developing WF or HRS (hazard ratio [HR] 0.7 [0.5-1.0], p = 0.03) than those with larger cysts but a similar risk of developing HGD or PC (p > 0.05). Slow growth was protective against the development of WF or HRS (HR 0.4 [0.2-0.6], p < 0.001) and HGD or PC (HR 0.04 [95% CI 0.02-0.12], p < 0.001). Individuals with small, stable sized cysts without baseline WF or HRS did not have a higher risk of HGD or PC than the general population (standardized incidence ratio [SIR] 1.13 [95% CI 0.01-6.30]).
CONCLUSION: Cyst size < 15 mm and growth rate < 2.5 mm/year appear to be "reassuring" features associated with a negligible risk of developing WF or HRS and HGD or PC. For cysts with these characteristics-and without baseline WF or HRS-less intensive surveillance (than currently recommended) or even cessation may be appropriate.