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 17 October 2017

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News

Competing risks for mortality in patients with asymptomatic pancreatic cystic neoplasms

The most recent issue of the American Journal of Gastroenterology examines competing risks for mortality in patients with asymptomatic pancreatic cystic neoplasms, and investigates the implications for clinical management.

News image

Pancreatic cystic neoplasms are being detected with increased frequency. Current clinical practice guidelines emphasize management based on cyst-related features.

Dr Karl Kwok and colleagues from California, USA evaluated the impact of comorbidity on mortality in pancreatic cystic neoplasms patients via competing risk analysis.

The researchers analyzed a retrospective cohort of patients diagnosed between 2005–2010, with follow-up through 2015, for overall and cause-specific mortality.

Comorbidities were classified by the Charlson comorbidity index.

22% of patient deaths occurred during the study period
American Journal of Gastroenterology

The researchers used Cox proportional hazards regression to evaluate the independent effect of cyst features, age, gender, and comorbidities on cause-specific mortality.

Subgroup analysis was performed to determine the cause-specific mortality based on 4 a priori clinical profiles—healthy patients with low- or high-risk cysts, and high-comorbidity patients with low- or high-risk cysts.

The team found that a total of 1,800 patients with pancreatic cystic neoplasms comprized the study cohort.

The researchers found that 22% of patient deaths occurred during the study period, of which 43 had pancreatic cancer, and 359 non-pancreatic cancer deaths.

Compared to healthy patients without any high-risk cyst features, patients with high comorbidity as well as high-risk cyst features had an increased risk of overall mortality, pancreatic cancer mortality, as well as non-pancreatic cancer mortality.

Meanwhile, the researchers found that low-risk patients with a high-risk cyst were more likely to experience pancreatic cancer mortality rather than non-pancreatic cancer mortality, compared to the reference group.

Similarly, compared to the reference group, the team noted that high-risk patients with a low-risk cyst were more likely to experience non-pancreatic cancer mortality rather than pancreatic cancer mortality.

Dr Kwok's team concludes, "Most of the deaths in the study were unrelated to pancreatic cancer."

"This has implications for clinical management."

"By applying patient-related factors in conjunction with cyst features, we defined commonly encountered patient profiles to help guide pancreatic cystic neoplasm clinical management."

Am J Gastroenterol 2017; 112: 1330–1336
17 August 2017

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