title: Low Rates of Malignancy and Mortality in Asymptomatic Patients With Suspected Neoplastic Pancreatic Cysts Beyond 5 Years of Surveillance.
abstract: The 2015 American Gastroenterological Association guidelines recommend discontinuation of surveillance of pancreatic cysts after 5 years, although there are limited data to support this recommendation. We aimed to determine the rate of pancreatic cancer development from neoplastic pancreatic cysts after 5 years of surveillance.
  
  
  
  We performed a retrospective multicenter study, collecting data from 310 patients with asymptomatic suspected neoplastic pancreatic cysts, identified by endoscopic ultrasound from January 2002 to June 2010 at 4 medical centers in California. All patients were followed up for 5 years or more (median, 87 mo; range, 60-189 mo). Data were used to calculate the risk for pancreatic cancer and all-cause mortality.
  
  
  
  Three patients (1%) developed invasive pancreatic adenocarcinoma. Based on American Gastroenterological Association high-risk features (cyst size > 3 cm, dilated pancreatic duct, mural nodule), risks for cancer were 0%, 1%, and 15% for patients with 0, 1, or 2 high-risk features, respectively. Mortality from nonpancreatic causes was 8-fold higher than mortality from pancreatic cancer after more than 5 years of surveillance.
  
  
  
  There is a very low risk of malignant transformation of asymptomatic neoplastic pancreatic cysts after 5 years. Patients with pancreatic lesions and 0 or 1 high-risk feature have a less than 1% risk of developing pancreatic cancer, therefore discontinuation of surveillance can be considered for select patients. Patients with neoplastic pancreatic cysts with 2 high-risk features have a 15% risk of subsequent pancreatic cancer, therefore surgery or continued surveillance should be considered.
authors.affiliation: Division of Gastroenterology, University of California San Diego Health Sciences, La Jolla, California. Electronic address: wtkwong@ucsd.edu.
authors.forename: Wilson T
authors.initials: WT
authors.lastname: Kwong
authors.affiliation: Division of Gastroenterology, Kaiser Permanente San Diego Medical Center, San Diego, California.
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Hunt
authors.affiliation: Division of Gastroenterology, University of California San Diego Health Sciences, La Jolla, California.
authors.forename: Syed M
authors.initials: SM
authors.lastname: Fehmi
authors.affiliation: Biostatistics Unit, Clinical and Translational Research Institute, La Jolla, California.
authors.forename: Gordon
authors.initials: G
authors.lastname: Honerkamp-Smith
authors.affiliation: Department of Family Medicine and Public Health, University of California San Diego Health Sciences, La Jolla, California.
authors.forename: Ronghui
authors.initials: R
authors.lastname: Xu
authors.affiliation: Department of Gastroenterology, Naval Medical Center, San Diego, California.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Lawson
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Tang
authors.affiliation: Division of Gastroenterology, University of California San Diego Health Sciences, La Jolla, California.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Gonzalez
authors.affiliation: Division of Gastroenterology, University of California San Diego Health Sciences, La Jolla, California.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Krinsky
authors.affiliation: Division of Gastroenterology, Kaiser Permanente Anaheim Medical Center, Anaheim, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Giap
authors.affiliation: Division of Gastroenterology, University of California San Diego Health Sciences, La Jolla, California.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D019160:Endosonography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000150:complications* / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
keywords: Intraductal Papillary Mucinous Neoplasm; Natural History; Pancreas; Tumor