Klaus Sahora1, Cristina R Ferrone1, William R Brugge2, Vicente Morales-Oyarvide1, Andrew L Warshaw1, Keith D Lillemoe1, Carlos Fernández-del Castillo3. 1. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 2. Department of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 3. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: CFERNANDEZ@mgh.harvard.edu.
Abstract
BACKGROUND & AIMS: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas occur mostly in older individuals. Individual life expectancy and risk of death from other factors must be carefully considered in analyzing the risks that IPMNs pose. We investigated whether there is a subset of patients with IPMNs and a high risk of dying from other causes who would not benefit from pancreatic surgery. METHODS: We collected data from 725 patients at Massachusetts General Hospital who underwent resection or have been under observation for IPMNs from 1992 through 2012. Comorbidities were classified according to the age-adjusted Charlson comorbidity index (CACI). Causes of death were recorded, and survival data were analyzed by the Kaplan-Meier method. RESULTS: The patients' median CACI score was 3; 10% of patients had CACI of 7 or more. Of the entire cohort, 55% underwent resection, and the remaining 45% have been under observation. After a median follow-up period of 5 years, 177 patients died (24%, 55% of deaths within 5 years of diagnosis); 78% of deaths were not related to IPMNs. The median survival time for all patients with CACI score of 7 or more was 43 months. Multivariate regression analysis revealed that the chance of non-IPMN-related death within 3 years of diagnosis is 11-fold higher for patients with CACI score of 7 or more than for patients with lower scores. CONCLUSIONS: The CACI can be used to identify patients with a high risk of death from factors other than IPMNs within a few years after diagnosis. These patients are therefore not likely to benefit from further IPMN observation or pancreatic resection.
BACKGROUND & AIMS:Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas occur mostly in older individuals. Individual life expectancy and risk of death from other factors must be carefully considered in analyzing the risks that IPMNs pose. We investigated whether there is a subset of patients with IPMNs and a high risk of dying from other causes who would not benefit from pancreatic surgery. METHODS: We collected data from 725 patients at Massachusetts General Hospital who underwent resection or have been under observation for IPMNs from 1992 through 2012. Comorbidities were classified according to the age-adjusted Charlson comorbidity index (CACI). Causes of death were recorded, and survival data were analyzed by the Kaplan-Meier method. RESULTS: The patients' median CACI score was 3; 10% of patients had CACI of 7 or more. Of the entire cohort, 55% underwent resection, and the remaining 45% have been under observation. After a median follow-up period of 5 years, 177 patients died (24%, 55% of deaths within 5 years of diagnosis); 78% of deaths were not related to IPMNs. The median survival time for all patients with CACI score of 7 or more was 43 months. Multivariate regression analysis revealed that the chance of non-IPMN-related death within 3 years of diagnosis is 11-fold higher for patients with CACI score of 7 or more than for patients with lower scores. CONCLUSIONS: The CACI can be used to identify patients with a high risk of death from factors other than IPMNs within a few years after diagnosis. These patients are therefore not likely to benefit from further IPMN observation or pancreatic resection.
Authors: Simeon Springer; David L Masica; Marco Dal Molin; Christopher Douville; Christopher J Thoburn; Bahman Afsari; Lu Li; Joshua D Cohen; Elizabeth Thompson; Peter J Allen; David S Klimstra; Mark A Schattner; C Max Schmidt; Michele Yip-Schneider; Rachel E Simpson; Carlos Fernandez-Del Castillo; Mari Mino-Kenudson; William Brugge; Randall E Brand; Aatur D Singhi; Aldo Scarpa; Rita Lawlor; Roberto Salvia; Giuseppe Zamboni; Seung-Mo Hong; Dae Wook Hwang; Jin-Young Jang; Wooil Kwon; Niall Swan; Justin Geoghegan; Massimo Falconi; Stefano Crippa; Claudio Doglioni; Jorge Paulino; Richard D Schulick; Barish H Edil; Walter Park; Shinichi Yachida; Susumu Hijioka; Jeanin van Hooft; Jin He; Matthew J Weiss; Richard Burkhart; Martin Makary; Marcia I Canto; Michael G Goggins; Janine Ptak; Lisa Dobbyn; Joy Schaefer; Natalie Sillman; Maria Popoli; Alison P Klein; Cristian Tomasetti; Rachel Karchin; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Christopher L Wolfgang; Ralph H Hruban; Anne Marie Lennon Journal: Sci Transl Med Date: 2019-07-17 Impact factor: 17.956
Authors: Stefano Crippa; Paolo G Arcidiacono; Francesco De Cobelli; Massimo Falconi Journal: United European Gastroenterol J Date: 2019-12-09 Impact factor: 4.623