Cancer incidence uncommon among low-risk pancreatic cysts during extended surveillance

Low-risk branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) appear to have a positive outlook, with the results of a recent meta-analysis showing that the incidence of advanced neoplasia during extended surveillance is low.

Researchers searched multiple online databases for studies whose outcomes included the incidence of worrisome features (WF) and high-risk stigmata (HRS) and advanced neoplasia, disease-specific mortality, and surveillance-related harm (expressed as percentage per patient-years).

A total of 41 studies met the eligibility criteria, but only 18 were included in the meta-analysis. These studies comprised a total of 10,345 participants with low-risk presumed BD-IPMNs at baseline, with a follow-up evaluation of more than 58,951.93 patient-years.

Pooled data showed that the incidence of WF/HRS among low-risk BD-IPMNs was 2.2 percent (95 percent confidence interval [CI], 1.0–3.7) during initial surveillance and 2.9 percent (95 percent CI, 1.0–5.7) during extended surveillance. The corresponding incidence of advanced neoplasia was 0.6 percent (95 percent CI, 0.2–1.0) and 1.0 percent (95 percent CI, 0.6–1.5).

Meanwhile, the pooled incidence of disease-specific mortality was 0.3 percent (95 percent CI, 0.1–0.6) during initial surveillance and 0.6 percent (95 percent CI, 0.0–1.6) during extended surveillance.

Among BD-IPMNs with initial size stability, WF/HRS and advanced neoplasia had an incidence of 1.9 percent (95 percent CI, 1.2–2.8) and 0.2 percent (95 percent CI, 0.1–0.5), respectively, over extended surveillance.

Despite the good outlook, the survival benefit of surveillance among the present population warrants further exploration through high-quality studies before recommending surveillance cessation with certainty, according to the researchers.