Comorbidities Drive the Majority of Overall Mortality in Low-risk Mucinous Pancreatic Cysts under Surveillance. Comorbidities Drive the Majority of Overall Mortality in Low-Risk Mucinous Pancreatic Cysts Under Surveillance.

MedStar author(s):
Citation: Clinical Gastroenterology & Hepatology. 20(3):631-640.e1, 2022 03.PMID: 33309984Institution: MedStar Union Memorial HospitalForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Pancreatic Cyst | *Pancreatic Neoplasms | Comorbidity | Humans | Pancreatic Cyst/ep [Epidemiology] | Pancreatic Neoplasms/ep [Epidemiology] | Prospective Studies | Retrospective StudiesYear: 2022ISSN:
  • 1542-3565
Name of journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological AssociationAbstract: BACKGROUND & AIMS: The Charlson Comorbidity Index (CACI) has been suggested as a tool to determine comorbidity burden and guide management for patients with mucinous pancreatic cysts (Intrapapillary Mucinous Neoplasms and Mucinous Cystic Neoplasms), but has not been studied well among "low-risk" mucinous pancreatic cysts i.e. without worrisome features (WF) and high-risk stigmata (HRS). This study sought to determine the comorbidity burden among surveillance population of low-risk pancreatic cysts and provide their follow-up mortality outcomes.CONCLUSION: Through real-time application of CACI to patient outcomes, our analysis supports incorporation of this comorbidity assessment tool in making shared surveillance decisions among low-risk pancreatic cyst population. Copyright (c) 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.METHODS: A single center study retrospectively reviewed a prospective pancreatic cyst database and included individuals with low-risk cysts undergoing serial imaging during 2016. Electronic medical records were reviewed to determine their baseline age-adjusted CACI (age-CACI). After 4 years, their progression to WF, disease specific (pancreatic malignancy-related, DSM), extra-pancreatic (EPM), and overall mortalities (OM) were determined using Kaplan-Meir Survival Analysis.RESULTS: 502 individuals underwent prospective surveillance. The study included 440 individuals with low-risk suspected or presumed mucinous cysts and excluded 50 and 12 individuals with WF and HRS respectively. Over a median follow-up of 56 months, 12 WF progressions, 2 DSMs, 42 EPMs, and 44 OMs were observed. Baseline age-CACI had good predictive capacity for 4-year EPM (Area-Under Curve: 0.87; p<.0001). The median age-CACI of 4 enabled cohort stratification into Low (age-CACI <4) and High CACI (age-CACI >=4) groups. A significantly higher OM (p<.001) was observed among the High CACI group as compared to the Low CACI group.All authors: Aslanian H, Chhoda A, Farrell JJ, Jamidar PA, Kunstman J, Madhani K, Muniraj T, Salem RA, Suarez AL, Yousaf MNOriginally published: Clinical Gastroenterology & Hepatology. 2020 Dec 10Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-12-31
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Journal Article MedStar Authors Catalog Article 33309984 Available 33309984

BACKGROUND & AIMS: The Charlson Comorbidity Index (CACI) has been suggested as a tool to determine comorbidity burden and guide management for patients with mucinous pancreatic cysts (Intrapapillary Mucinous Neoplasms and Mucinous Cystic Neoplasms), but has not been studied well among "low-risk" mucinous pancreatic cysts i.e. without worrisome features (WF) and high-risk stigmata (HRS). This study sought to determine the comorbidity burden among surveillance population of low-risk pancreatic cysts and provide their follow-up mortality outcomes.

CONCLUSION: Through real-time application of CACI to patient outcomes, our analysis supports incorporation of this comorbidity assessment tool in making shared surveillance decisions among low-risk pancreatic cyst population. Copyright (c) 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

METHODS: A single center study retrospectively reviewed a prospective pancreatic cyst database and included individuals with low-risk cysts undergoing serial imaging during 2016. Electronic medical records were reviewed to determine their baseline age-adjusted CACI (age-CACI). After 4 years, their progression to WF, disease specific (pancreatic malignancy-related, DSM), extra-pancreatic (EPM), and overall mortalities (OM) were determined using Kaplan-Meir Survival Analysis.

RESULTS: 502 individuals underwent prospective surveillance. The study included 440 individuals with low-risk suspected or presumed mucinous cysts and excluded 50 and 12 individuals with WF and HRS respectively. Over a median follow-up of 56 months, 12 WF progressions, 2 DSMs, 42 EPMs, and 44 OMs were observed. Baseline age-CACI had good predictive capacity for 4-year EPM (Area-Under Curve: 0.87; p<.0001). The median age-CACI of 4 enabled cohort stratification into Low (age-CACI <4) and High CACI (age-CACI >=4) groups. A significantly higher OM (p<.001) was observed among the High CACI group as compared to the Low CACI group.

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