The risk for pancreatic cystic neoplasms to progress to pancreatic cancer is small in patients with low-risk cystic lesions but appears to increase linearly with time, according to data from a retrospective analysis presented at the 2020 American College of Gastroenterology (ACG) Annual Scientific Meeting. Findings from the evaluation also suggested that the development of new onset diabetes correlates with a “significantly higher” risk for progression, according to the study authors.

Using ICD-9/10 codes, the investigators sourced 14,279 patients with low-risk pancreatic cysts from the IBM Marketscan insurance claims databases. These patients were evaluated for at least 2 years after receiving pancreatic cyst diagnoses. The risk for progression to pancreatic cancer and the association of progression with metabolic status were evaluated using Kaplan-Meier analysis and Cox proportional hazard modeling. Results were standardized by age and insurance coverage.

At 5 years, the adjusted cumulative progression rate to pancreatic cancer was 2.2% (95% CI, 1.8%-2.6%). The cumulative risk for progression increased at a “nearly linear rate” over a 7-year period (0.979; P <.001). A history of diabetes (HR, 2.01; 95% CI, 1.89-2.14) and the development of new-onset diabetes following cyst diagnosis (HR, 3.24; 95% CI, 3.03-3.46) were both associated with a greater risk for progression.

The 5-year adjusted progression rate to pancreatic cancer for patients without diabetes was 1.5% (95% CI, 1.1%-1.9%). Additionally, the 5-year adjusted progression rate was 3.1% (95% CI, 2.1%-4.1%) for patients with a prior history of diabetes and 4.6% (95% CI, 3.1%-6.1%) for patients who presented with new-onset diabetes after cyst diagnosis.


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Although investigations into the risk for pancreatic cysts to progress to pancreatic cancer have been extensive, to date, they have been limited by small sample sizes and selection bias. These limitations have translated to “highly variable progression results,” which contribute to the difficulty of identifying reliable novel risk factors and biomarkers for malignant transformation, according to the investigators. The study is the “first large scale, real-world study of the malignant progression of low-risk pancreatic cysts,” they said.

In their discussion, the researchers of this study concluded that their findings “support the inclusion of HbA1C, fasting glucose, and other markers of diabetes mellitus in cyst surveillance algorithms,” considering that new-onset diabetes is associated with an increased risk of progression.

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Reference

Schweber A, Brooks C, Agarunov E, Gonda T. Using large sample real world data to study the progression of low risk pancreatic cysts: New onset diabetes as a potential biomarker of malignant transformation.  Presented at: American College of Gastroenterology Annual Scientific Meeting; October 26-28, 2020. Abstract S0001.