Small and Stable Pancreatic Cysts Are Reassuring During Surveillance: Results From the PACYFIC Trial.

IF 5.8 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

United European Gastroenterology Journal Pub Date : 2025-06-18 DOI:10.1002/ueg2.70043

Iris J M Levink, Marloes L J A Sprij, Brechtje D M Koopmann, Jihane Meziani, Sanne Jaarsma, Priscilla A van Riet, Kasper A Overbeek, Myrte Gorris, Rogier P Voermans, Jeanin E van Hooft, Riccardo Casadei, Mariacristina Di Marco, Michael B Wallace, Sanne A Hoogenboom, Neville Azopardi, Reea Ahola, Marcin Polkowski, Pieter Honkoop, Silvia Carrara, Erik J Schoon, Niels G Venneman, Laurens A van der Waaij, Anne-Marie van Berkel, Gemma Rossi, Jilling F Bergmann, Elizabeth Pando, Georg Beyer, Matthijs P Schwartz, Frederike G I van Vilsteren, Chantal Hoge, Marianne E Smits, Rutger Quispel, Ellert J van Soest, Patrick M Vos, Robert C Verdonk, Toon Steinhauser, Eva Kouw, Adriaan C I T L Tan, Laszlo Czako, Marco J Bruno, Djuna L Cahen

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引用次数: 0

Abstract

Background: Pancreatic cysts are increasingly discovered on imaging studies performed for unrelated conditions. Currently, surveillance of these lesions poses a substantial burden on patients, and health care recourses. We hypothesized that individuals with small and stable cysts have a diminutive risk of progressing to high-grade dysplasia (HGD) or pancreatic cancer (PC) that is similar to that in the general population.

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.

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监测期间小而稳定的胰腺囊肿是令人放心的：PACYFIC试验的结果。

背景：胰腺囊肿越来越多地在影像学检查中被发现。目前，对这些病变的监测对患者和卫生保健资源构成了沉重的负担。我们假设，具有小而稳定囊肿的个体发展为高级别发育不良（HGD）或胰腺癌（PC）的风险与一般人群相似。方法：这项巢式pacyfic研究是欧洲和北美44个中心的合作，研究了不同囊肿大小和生长速度的HGD和PC的风险，参与者没有基线担忧特征（WF）或高风险柱头（HRS）。结果：在2369名PACYFIC参与者中，975名符合纳入标准，平均年龄为67岁（SD 13）， 65%为女性。其中，438人（45%）的基线囊肿较小（0.05）。生长缓慢对WF或HRS的发展具有保护作用（HR为0.4 [0.2-0.6],p）

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来源期刊

United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

10.50

自引率

13.30%

发文量

147

期刊介绍： United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.