Stratification Based on Risk Factors at Diagnosis Could Predict Progression in Patients with Pancreatic Cysts

Abstract

Background: Predicting the risk of malignant transformation in pancreatic cyst patients is challenging.

Aim: We retrospectively investigated the risk factors for malignant transformation in pancreatic cyst patients.

Methods: Patients with pancreatic cysts diagnosed using imaging tests were followed from November 2008 to December 2021. A significant change was defined as the additional development of high-risk stigmata (HRS), worrisome features (WFs), or pancreatic cancer during monitoring.

Results: In total, 479 patients were analyzed, with a median observation period of 50 months. Forty-four patients (9.2%) showed significant changes, and eight (1.7%) developed pancreatic cancer. The univariate analysis showed that the cyst diameter at diagnosis (≥ 14 mm), main pancreatic duct (MPD) diameter at diagnosis (≥ 3 mm), presence of multilocular cysts, and an inconsistent MPD caliber were significant predictive factors for a significant change. One point was assigned for each significant factor. We grouped the patients into three groups: the low-risk group (total score 0), medium-risk group (score 1-2), and high-risk group (score 3-4). The high-risk group had a higher risk of a significant change than the medium- and low-risk groups (age-adjusted HRs for the medium-risk and high-risk groups were 3.0 and 5.2 compared with the low-risk group).

Conclusion: Stratification based on risk factors may help predict the development of significant changes in pancreatic cyst patients.

Keywords: Concomitant cancer; Cyst-derived cancer; Intraductal papillary mucinous neoplasms; Pancreatic cancer; Pancreatic cyst.