Motasem Alkhayyat, MD1, Mohannad Abou Saleh, MD1, Farhan M. Qayyum, DO, MA2, Woan Kim, DO1, Ashraf Almomani, MD1, Alaa Habash, MD1, Carlos Roberto Simons-Linares, MD, MSc1, Prabhleen Chahal, MD1; 1Cleveland Clinic Foundation, Cleveland, OH; 2Cleveland Clinic Foundation, Warrensville Heights, OH
Introduction: Statins are thought to have an anti-inflammatory and chemopreventative role in several gastrointestinal diseases, namely hepatocellular carcinoma and portal hypertension. There is limited data on the effect of statins on pancreatic cysts (PC). We aim to examine the effects of statins on the rate of growth, high-risk transformation, malignant transformation and surgical intervention of PC over a 10-year period. Methods: A cohort study of patients with abdominal imaging (MRI, CT) findings of PC from 2008-2018 was conducted. Patients older than 18 without a history of pancreatic surgery or cancer, with a 10-year follow up and data on initial diagnosis were included. Patients with statin use were identified and compared to non-statin users and to non-statin non-aspirin users. Outcomes were measured at 1,3,5, and 10 years. These included new or recurrent cysts, rate of growth, high-risk, and malignant transformation (Table 1). 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 increased growth overtime. Results: Of the 2,500 patients evaluated, 1,789 met the inclusion criteria. There were 80.3% intraductal papillary mucinous neoplasms (IPMN) (97.3% side branch). There were 394 (22%) patients with concomitant statin and aspirin use and 195 (11%) patients with pure statin use. Statin users with PC were more likely to be older [p< 0.001], with higher Charlson comorbidity score [p< 0.001]. They were more likely to have PC with multilocular morphology [p=0.031] and experience cyst growth at 1-2, 3-5, 5-10 and >10 years [p< 0.002 for all]. In univariable analysis, statin was associated with increased high-risk transformation amongst chronic pancreatitis patients [HR: 27.93;(2.34-333.03)] and diabetic patients [HR: 16.08;(3.05-84.84)]. In multivariate analysis, statin was associated with increased rate of growth over time [HR: 1.51;(1.01-2.25)]. There were no statistically significant associations between statin use and high-risk transformation, malignant transformation or surgical intervention. Discussion: This is one of the few long-term studies to describe the effects of statin on PC. Statin use appears to be associated with increased rate of growth over time without increase in high risk or malignant transformation. The underlying mechanism of this association is unclear and further long-term studies are needed to confirm these findings and their clinical implications.
Table 1: Features of high-risk and malignant transformation studied
Table 2. Multivariable Predictors of Any Change in Growth (Size or Number) –in Statin users
Disclosures: Motasem Alkhayyat indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Farhan Qayyum indicated no relevant financial relationships. Woan Kim indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Alaa Habash indicated no relevant financial relationships. Carlos Roberto Simons-Linares indicated no relevant financial relationships. Prabhleen Chahal indicated no relevant financial relationships.