P1444 - Analysis of Pancreatic Cystic Lesions and Factors Associated With Pancreas Adenocarcinoma Development From 2000 to 2023 at a Tertiary Care Oncology Center

Daniel J. Low, MD¹, Iyad S.. Al-Bustami, MD², William A Ross, MD³, Brian R. Weston, MD³, Emmanuel Coronel, MD³, Ahmad Nakshabandi, MD⁴, Phillip Ge, MD³, Jeffrey H. Lee, MD, MPH^3
1MD Anderson Cancer Center, Houston, TX; ²University of Texas Health Science Center at Houston, Houston, TX; ³University of Texas MD Anderson Cancer Center, Houston, TX; ⁴UT MD Anderson Cancer Center, Houston, TX

Introduction: The optimal strategy for pancreas cyst management is unclear. Several risk factors have been reported for the development of pancreas cancer including cyst size, main duct dilation and mural nodularity. However, most patients undergoing surgery do not have invasive carcinoma or high-grade dysplasia on pathology.

Methods: The aim of the study was to evaluate risk factors for cyst progression to pancreatic adenocarcinoma. A retrospective analysis was conducted at MD Anderson Cancer Center evaluating all pancreas cysts identified on EUS between January 2000 and April 2023. Inclusion criteria included age >18, at least two interval cross sectional images and at least one EUS examination. The exclusion criteria included predominantly solid lesions with cystic components on EUS. Patient and cyst characteristics are found in table 1. Factors associated with pancreas cancer were evaluated with univariate and multivariate logistic regression (table 1).

Results: 3817 EUS reports were identified in the study period. 813 lesions met inclusion and exclusion criteria. There were 524 (64.5%) IPMNs, 112 (13.8%) SCAs, 26 (3.2%) MCNs, and 152 (18.7%) unspecified cysts without a clear diagnosis. 34 (4.2%) patients developed pancreas cancer, of which 12 (2.7%) arose from BD-IPMN (n=438). Pancreas cancer was associated with cyst wall thickening on EUS (OR 3.32;1.02–10.79), unspecified cyst type (OR 3.80;1.04–13.85), initial PD dilation on imaging (OR 3.95;1.14–13.61), diabetes (OR 3.25;1.17–9.01), development of high risk features (OR 4.12;1.11–15.25), development of an associated mass (OR 17.56;3.87–79.73), and age (OR 1.08;1.01–1.15). When adjusting for BD-IPMN, pancreas cancer was associated with male sex (OR 12.76;1.18–137.56), PD dilation >5mm on EUS (OR 18.07;2.30–141.76), development of an associated mass (OR 25.78;2.71–244.83) and evolution of cyst size to >30mm (OR 6.96;1.03–46.86). In patients undergoing surgery (n=96;11.8%), 38 (40.0%) patients had pathology consistent with adenocarcinoma (n=6;6.3%) or high-grade dysplasia (n=32;33.3%).

Discussion: A large retrospective analysis was conducted evaluating endoscopic, imaging, and patient factors associated with pancreas cancer development. Male sex, PD dilation on EUS, interim development of mass on imaging, and evolution of cyst size to >30mm were associated with BD-IPMN progression to pancreas cancer. Current surveillance criteria require improvement for greater sensitivity and specificity of cyst management.


Disclosures:


Daniel J. Low, MD¹, Iyad S.. Al-Bustami, MD², William A Ross, MD³, Brian R. Weston, MD³, Emmanuel Coronel, MD³, Ahmad Nakshabandi, MD⁴, Phillip Ge, MD³, Jeffrey H. Lee, MD, MPH³. P1444 - Analysis of Pancreatic Cystic Lesions and Factors Associated With Pancreas Adenocarcinoma Development From 2000 to 2023 at a Tertiary Care Oncology Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.