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Effects of Comorbidities on Outcomes of Patients With Intraductal Papillary Mucinous Neoplasms
- Source :
- Clinical Gastroenterology and Hepatology. 13:1816-1823
- Publication Year :
- 2015
- Publisher :
- Elsevier BV, 2015.
-
Abstract
- Background & Aims Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas occur mostly in older individuals. Individual life expectancy and risk of death from other factors must be carefully considered in analyzing the risks that IPMNs pose. We investigated whether there is a subset of patients with IPMNs and a high risk of dying from other causes who would not benefit from pancreatic surgery. Methods We collected data from 725 patients at Massachusetts General Hospital who underwent resection or have been under observation for IPMNs from 1992 through 2012. Comorbidities were classified according to the age-adjusted Charlson comorbidity index (CACI). Causes of death were recorded, and survival data were analyzed by the Kaplan-Meier method. Results The patients' median CACI score was 3; 10% of patients had CACI of 7 or more. Of the entire cohort, 55% underwent resection, and the remaining 45% have been under observation. After a median follow-up period of 5 years, 177 patients died (24%, 55% of deaths within 5 years of diagnosis); 78% of deaths were not related to IPMNs. The median survival time for all patients with CACI score of 7 or more was 43 months. Multivariate regression analysis revealed that the chance of non-IPMNārelated death within 3 years of diagnosis is 11-fold higher for patients with CACI score of 7 or more than for patients with lower scores. Conclusions The CACI can be used to identify patients with a high risk of death from factors other than IPMNs within a few years after diagnosis. These patients are therefore not likely to benefit from further IPMN observation or pancreatic resection.
- Subjects :
- Endoscopic ultrasound
medicine.medical_specialty
endocrine system diseases
Hepatology
medicine.diagnostic_test
Intraductal papillary mucinous neoplasm
business.industry
Gastroenterology
medicine.disease
Confidence interval
Surgery
medicine.anatomical_structure
Cohort
medicine
Risk of death
General hospital
Pancreas
business
Median survival
Subjects
Details
- ISSN :
- 15423565
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- Clinical Gastroenterology and Hepatology
- Accession number :
- edsair.doi...........5e628d1937d22d2fd0eba2419ee86896
- Full Text :
- https://doi.org/10.1016/j.cgh.2015.04.177