Surveillance for Pancreatic Cancer in High-Risk Individuals Leads to Improved Outcomes: A Propensity Score-Matched Analysis

Klatte, Derk C.F.; Boekestijn, Bas; Onnekink, A.; Dekker, Friedo W.; Geest, Lydia G. van der; Wasser, Martin; Feshtali, Shirin; Mieog, J. Sven D.; Luelmo, Saskia; Morreau, Hans; Potjer, Thomas P.; Inderson, Akin; Boonstra, Jurjen J.; Vasen, Hans F. A.; Hooft, Jeanin E. van; Bonsing, Bert A.; Leerdam, Monique E. van

doi:10.1053/j.gastro.2023.02.032

Cited by 37 publications

(19 citation statements)

References 29 publications

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“…Pathology revealed a pT1cN1M PC. Carriers of CDKN2A mutation have a 19% lifetime risk of PC (9,10) and we confirm the relevance of performing PC surveillance lifelong.…”

Section: Discussionsupporting

confidence: 75%

“…Because a population-wide screening is not feasible, attention has been focused on HRI, which have a different risk profile according to the type of predisposition (6). Indeed, the PC detection rate seems to differ substantially between HRI with familial predisposition and with confirmed genetic predisposition, being much higher, if not exclusive, in the latter, with impactful results in radical surgical treatment and long-term survival (5,(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of a 3-Year Prospective Surveillance in Individuals at High Risk of Pancreatic Cancer

Paiella,

Capurso,

Carrara

et al. 2023

Am J Gastroenterol

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Introduction: Pancreatic cancer (PC) surveillance of high-risk individuals (HRI) is becoming more common worldwide, aiming at anticipating PC diagnosis at a pre-clinical stage. In 2015 the Italian Registry of Families at Risk of Pancreatic Cancer (IRFARPC) was created. We aimed to assess the prevalence and incidence of pancreatic findings, oncological outcomes, and harms seven years after the Italian Registry of Families at Risk of Pancreatic Cancer (IRFARPC) inception focusing on individuals with at least a 3-year follow-up or developing events before. Methods: HRI (subjects with family history or mutation carriers with/without family history were enrolled in 18 Centers. They underwent annual magnetic resonance with cholangiopancreatography or endoscopic ultrasound (NCT04095195). Results: During the study period (June 2015 – September 2022), 679 individuals were enrolled. Of these, 524 (77.2%) underwent at least baseline imaging, and 156 (29.8%) with at least a 3-year follow-up or pancreatic malignancy/pre-malignancy-related events, and represented the study population. Median age was 51 (IQR 16). Familial PC cases (FPC) accounted for 81.4% of HRI, and individuals with pathogenic variant (PV) for 18.6%. Malignant (n=8) and pre-malignant (1 PanIN3) lesions were found in nine individuals. Five of these 8 cases occurred in PV carriers, four in FPC cases (two tested negative at germline testing, and two others were not tested). Three of the 8 PC were Stage I. Five of the 8 PC were resectable, 3 Stage I, all advanced cases being prevalent. The 1-, 2-, and 3-year cumulative hazard of PC was 1.7%, 2.5% and 3%, respectively. Median overall and disease-free survival of resected PC patients were 18 and 12 months (95%CI not computable). Considering HRI who underwent baseline imaging, six pancreatic neuroendocrine neoplasms (one resected) and one low-yield surgery (low-grade mixed-IPMN) were also reported. Conclusion: PC surveillance in a fully public healthcare system is feasible, safe, and leads to early PC or pre-malignant lesions diagnoses, mostly at baseline but also over time.

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“…Pathology revealed a pT1cN1M PC. Carriers of CDKN2A mutation have a 19% lifetime risk of PC (9,10) and we confirm the relevance of performing PC surveillance lifelong.…”

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Outcomes of a 3-Year Prospective Surveillance in Individuals at High Risk of Pancreatic Cancer

Paiella,

Capurso,

Carrara

et al. 2023

Am J Gastroenterol

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“…Emerging research in patients meeting highrisk criteria show promise in increasing detection of surgically resectable PDAC, with one study demonstrating a 90% 1-year survival and 60% 5-year survival (1,6) among those identified in a screening protocol. More recent studies have conferred in demonstrating earlier detection, increased resectability, and improved survival as compared with nonscreening patients with PDAC (7). Most cost benefit models have supported the cost effectiveness of screening in enriched populations such as high-risk individuals and/or new onset diabetes (8,9).…”

Section: Introductionmentioning

confidence: 99%

A Blueprint for a Comprehensive, Multidisciplinary Pancreatic Cancer Screening Program

Fasullo,

Simeone,

Everett

et al. 2023

Am J Gastroenterol

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“…In addition, some studies have recently shown that pancreatic cancer surveillance leads to a survival benefit. [13][14][15] In 2017, a systematic review and patient-level meta-analysis of 13 studies, including 90 HRI operated within pancreatic cancer surveillance programs, reported that surgery was appropriate in 42.2% of cases, 16 but their reference for appropriateness was not based on the CAPS guidelines.…”

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confidence: 99%

“…Regarding the efficacy of pancreatic cancer surveillance, some meta-analyses have reported that the diagnostic yield of screening for asymptomatic pancreatic cancers or precursor lesions on HRI undergoing surveillance is high, 10–12 demonstrating that selected surveillance may lead to diagnosis anticipation. In addition, some studies have recently shown that pancreatic cancer surveillance leads to a survival benefit 13–15 . In 2017, a systematic review and patient-level meta-analysis of 13 studies, including 90 HRI operated within pancreatic cancer surveillance programs, reported that surgery was appropriate in 42.2% of cases, 16 but their reference for appropriateness was not based on the CAPS guidelines.…”

mentioning

confidence: 99%

Surveillance of Individuals at High Risk of Developing Pancreatic Cancer

Paiella,

Secchettin,

Lionetto

et al. 2023

Annals of Surgery

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Objective: To quantify the rate of low-yield surgery, defined as no high-grade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance. Summary Background Data: Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRI) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well-quantified. Methods: A systematic search and prevalence meta-analysis was performed for studies reporting surgery with final diagnoses other than those defined by the CAPS goals from January 2000 to July 2023. The secondary outcome was the pooled proportion of final diagnoses matching the CAPS goals (PROSPERO: #CRD42022300408). Results: Twenty-three articles with 5,027 patients (median 109 patients/study, IQR 251) were included. The pooled prevalence of low-yield surgery was 2.1% [95%CI 0.9-3.7], I2 83%). In the subgroup analysis, this prevalence was non-significantly higher in studies that only included familial pancreatic cancer (FPC) subjects without known pathogenic variants (PV), compared to those enrolling PV carriers. No effect modifiers were found. Overall, the pooled prevalence of subjects under surveillance who had a pancreatic resection that contained target lesions was 0.8% [95%CI 0.3-1.5], I2 24%). The temporal analysis showed that the rate of low-yield surgeries decreased in the last decades and stabilized at around 1% (test for subgroup differences P<0.01). Conclusions: The risk of “low-yield” surgery during pancreatic cancer surveillance is relatively low but should be thoroughly discussed with individuals under surveillance.

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Surveillance for Pancreatic Cancer in High-Risk Individuals Leads to Improved Outcomes: A Propensity Score-Matched Analysis

Cited by 37 publications

References 29 publications

Outcomes of a 3-Year Prospective Surveillance in Individuals at High Risk of Pancreatic Cancer

Outcomes of a 3-Year Prospective Surveillance in Individuals at High Risk of Pancreatic Cancer

A Blueprint for a Comprehensive, Multidisciplinary Pancreatic Cancer Screening Program

Surveillance of Individuals at High Risk of Developing Pancreatic Cancer

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