NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) REDUCE THE RISK OF PANCREATIC CYST GROWTH: RESULTS OF A 10-YEAR FOLLOW-UP STUDY

Aims The chemopreventitive action of NSAIDs was reported in previous studies. However, the effect of NSAIDs on pancreatic cysts (PC) remains unknown. We aim to evaluate the effects of NSAIDs on PC over a 10-year period.

Methods A cohort study of a prospectively maintained database of patients with abdominal imaging (MRI/CT) findings of PC from 2008-2018 was conducted. Patients without a history of pancreatic cancer, with a 10-year follow up and data on initial diagnosis were included. After excluding aspirin and statin, patients on NSAIDs were identified and compared to non-NSAIDs. Outcomes were measured at 1,3,5, and 10 years. These included increased growth, surgical intervention and high-risk transformation. Kaplan-Meier estimates and Cox proportional hazards models were used for time to high-risk transformation and surgery. Mixed effect logistic regression models were used to evaluate rate of growth overtime.

Results Of the 1,000 patients evaluated, 686 met the inclusion criteria. There were 80% IPMNs and 2.2% MCNs. There were 305 patients on NSAIDs (44.46%) and concomitant aspirin and/or statin use and 80 (11.66%) patients with only NSAID use. In multivariable analysis, NSAID use was associated with increased rate of high-risk transformation [HR: 1.11; 95% CI: 0.57-2.18; p=0.75] and surgery [HR: 1.24; 95% CI: 0.71-2.18; p=0.44], although this was not statistically significant. There was a decreased risk of growth among NSAID users when compared to those without NSAID, aspirin or statin use. This was significant over a 10-year period [OR: 0.48; 95% CI: 0.26-0.89; p=0.019].

Conclusions There is a protective effect of NSAIDs on the rate of growth of PC in this large 10 year follow up cohort study. This did not translate into reducing the rate of high-risk transformation or risk of surgery. This finding is not clinically applicable at this stage and further studies are needed.