Appropriateness of pancreatic resection in high-risk individuals for familial pancreatic ductal adenocarcinoma: a patient-level meta-analysis and proposition of the Beaujon score. Issue 3 (April 2019)

• Record Type: Journal Article
• Authors: de Mestier, Louis; Muller, Marie; Cros, Jérôme; Vullierme, Marie-Pierre; Vernerey, Dewi; Maire, Frédérique; Dokmak, Safi; Rebours, Vinciane; Sauvanet, Alain; Lévy, Philippe; Hammel, Pascal
• Is Part Of: United European Gastroenterology journal. Volume 7:Issue 3(2019)
• Page Start: 358
• Page End: 368
• Publication Date: 2019-04
• Subjects: Familial pancreatic carcinoma -- pancreatic neoplasm -- hereditary neoplastic syndromes -- cancer screening -- pancreatic surgery; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640618824910
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: About 5% of pancreatic ductal adenocarcinomas are inherited due to a deleterious germline mutation detected in 20% or fewer families. Pancreatic screening in high-risk individuals is proposed to allow early surgical treatment of (pre)malignant lesions. The outcomes of pancreatic surgery in high-risk individuals have never been correctly explored. Objectives: To evaluate surgical appropriateness and search for associated factors in high-risk individuals. Methods: A patient-level meta-analysis was performed including studies published since 1999. Individual classification distinguished the highest risk imaging abnormality into low-risk or high-risk abnormality, and the highest pathological degree of malignancy of lesions into no/low malignant potential or potentially/frankly malignant. Surgical appropriateness was considered when potentially/frankly malignant lesions were resected. Results: Thirteen out of 24 studies were selected, which reported 90 high-risk individuals operated on. Low-risk/high-risk abnormalities were preoperatively detected in 46.7%/53.3% of operated high-risk individuals, respectively. Surgical appropriateness was consistent in 38 (42.2%) high-risk individuals, including 20 pancreatic ductal adenocarcinomas (22.2%). Identification of high-risk abnormalities was strongly associated with surgical appropriateness at multivariate analysis ( P = 0.001). We proposed a score and nomogram predictive of surgical appropriateness, including high-risk abnormalities, age and existence of deleterious germline mutation. Conclusion: Overall, 42.2% of high-risk individuals underwent appropriate surgery. The proposed score might help selecting the best candidates among high-risk individuals for pancreatic resection.