Objective Cost-effectiveness of surveillance for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) is debated. We combined different categories of risks of IPMN progression and of IPMN-unrelated mortality to improve surveillance strategies. Design Retrospective analysis of 926 presumed BD-IPMNs lacking worrisome features (WFs)/high-risk stigmata (HRS) under surveillance. Charlson Comorbidity Index (CACI) defined the severity of comorbidities. IPMN relevant changes included development of WF/HRS, pancreatectomy or death for IPMN or pancreatic cancer. Pancreatic malignancy-unrelated death was recorded. Cumulative incidence of IPMN relevant changes were estimated using the competing risk approach. Results 5-year cumulative incidence of relevant changes was 17.83% and 1.6% developed pancreatic malignancy. 5-year cumulative incidences for IPMN relevant changes were 13.73%, 19.93% and 25.04% in low-risk, intermediate-risk and high-risk groups, respectively. Age ≥75 (HR: 4.15) and CACI >3 (HR: 3.61) were independent predictors of pancreatic malignancy-unrelated death. 5-year cumulative incidence for death for other causes was 15.93% for age ≥75+CACI >3 group and 1.49% for age <75+CACI ≤3. 5-year cumulative incidence of IPMN relevant changes were 13.94% in patients with age <75+CACI ≤3 compared with 29.60% in those with age ≥75+CACI >3. In this group 5-year rate of malignancy-free patients was 95.56% with a 5-year survival of 79.51%. Conclusion Although it is not uncommon the occurrence of changes considered by current guidelines as relevant during surveillance of low risk BD-IPMNs, malignancy rate is low and survival is significantly affected by competing patients’ age and comorbidities. IPMN surveillance strategy should be tailored based on these features and modulated over time. Data are available upon reasonable request.

中文翻译：

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年龄、合并症和相关变化对导管内乳头状粘液性肿瘤监测策略的影响：竞争风险分析

目的 分支导管内乳头状粘液性肿瘤 (BD-IPMN) 监测的成本效益存在争议。我们结合了不同类别的 IPMN 进展风险和与 IPMN 无关的死亡率，以改进监测策略。设计 对监测下的 926 个假定缺乏令人担忧特征 (WF)/高风险耻辱 (HRS) 的 BD-IPMN 进行回顾性分析。查尔森合并症指数 (CACI) 定义了合并症的严重程度。 IPMN 相关变化包括 WF/HRS 的发生、胰腺切除术或 IPMN 或胰腺癌死亡。记录了与胰腺恶性肿瘤无关的死亡。使用竞争风险方法估计 IPMN 相关变化的累积发生率。结果相关变化的5年累积发生率为17.83%，其中1.6%发展为胰腺恶性肿瘤。低危组、中危组和高危组IPMN相关变化的5年累积发生率分别为13.73%、19.93%和25.04%。年龄≥75岁（HR：4.15）和CACI>3（HR：3.61）是胰腺恶性肿瘤无关死亡的独立预测因素。年龄≥75+CACI>3组的其他原因死亡的5年累积发生率为15.93%，年龄<75+CACI≤3组为1.49%。年龄 <75+CACI ≤3 的患者中 IPMN 相关变化的 5 年累积发生率为 13.94%，而年龄 ≥75+CACI >3 的患者为 29.60%。该组患者5年无恶性肿瘤率为95.56%，5年生存率为79.51%。结论 虽然在低风险 BD-IPMN 监测过程中当前指南认为相关的变化的发生并不罕见，但恶性率较低，并且生存率受到竞争患者年龄和合并症的显着影响。 IPMN 监视策略应根据这些特征进行定制，并随着时间的推移进行调整。数据可根据合理要求提供。