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

Authors

Ankit Chhoda, Department of Internal Medicine, Bridgeport Hospital, Yale New Haven Health, New Haven, Connecticut.
Muhammad N. Yousaf, Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland.
Kamraan Madhani, Department of Internal Medicine, Yale Waterbury Internal Medicine Program, Yale School of Medicine, New Haven, Connecticut.
Harry Aslanian, Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut.Follow
Priya A. Jamidar, Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut.
Alejandro L. Suarez, Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut.
Ronald R. Salem, Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Thiruvengadam Muniraj, Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut.
John W. Kunstman, Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
James J. Farrell, Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut. Electronic address: james.j.farrell@yale.edu.

Document Type

Article

Publication Title

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

Abstract

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. 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. 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.

First Page

631

Last Page

640.e1

DOI

10.1016/j.cgh.2020.12.008

Publication Date

3-1-2022

Recommended Citation

Chhoda, Ankit; Yousaf, Muhammad N.; Madhani, Kamraan; Aslanian, Harry; Jamidar, Priya A.; Suarez, Alejandro L.; Salem, Ronald R.; Muniraj, Thiruvengadam; Kunstman, John W.; and Farrell, James J., "Comorbidities Drive the Majority of Overall Mortality in Low-Risk Mucinous Pancreatic Cysts Under Surveillance" (2022). All Research. 81.
https://scholar.bridgeporthospital.org/all_research/81

Identifier

33309984 (pubmed); 10.1016/j.cgh.2020.12.008 (doi); S1542-3565(20)31665-7 (pii)