Patients 65 years and older with incidental pancreatic cysts: Is there a relationship between all-cause mortality and imaging follow-up?

Abstract

Purpose: To assess the relationship between imaging follow-up and all-cause mortality in subjects ≥65 years with and without incidental pancreatic cysts (IPC).

Methods and materials: Patients ≥65 years with abdominal CT/MR 11/1/01-11/1/11 were included. IPC group included subjects with IPC on CT/MR report; No-IPC group was 3:1 frequency-matched on age decade, imaging modality and year of initial study from the pool without reported IPC. Demographics, date of last encounter, date of death, Charlson scores within 3 months before initial CT/MR and number of abdominal CTs and MRs performed after initial study were recorded. Logistic regression models with binary outcomes of death and having post-index imaging were constructed. Models were adjusted for age, race, sex, Charlson score and follow-up time. Subgroups were created based on interactions between variables.

Results: There were 1320 subjects in IPC group and 3805 in No-IPC group, with mean ages 79.1 (±8.0) and 78.8 (±8.0) years, respectively (p=0.293), and median follow-up times of 3.1 (IQR 0.74-5.26) and 3.0 (0.36-5.23) years, respectively (p=0.009). Adjusted odds ratios of post-index imaging for IPC were 2.18 (p<0.001) in subgroup<84years and follow-up <4years, 3.37 (p<0.001) in subgroup <84 years and follow-up ≥4 years, and 1.20 (p=0.201) in subgroup ≥84 years. Number of follow-up CTs and MRs was not independently associated with decreased odds of death in any subgroup.

Conclusion: Older subjects with IPC are more likely to undergo imaging follow-up compared to subjects without IPC, yet increasing number of follow-up studies does not decrease the odds of death.

Keywords: Imaging surveillance; Mortality; Pancreatic cysts.