Surveillance for pancreatic cancer in high-risk individuals. Issue 5 (2nd July 2019)

• Record Type: Journal Article
• Authors: Konings, I C A W; Canto, M I; Almario, J A; Harinck, F; Saxena, P; Lucas, A L; Kastrinos, F; Whitcomb, D C; Brand, R E; Lachter, J; Malleo, G; Paiella, S; Syngal, S; Saltzman, J R; Stoffel, E M; Hooft, J E; Hruban, R H; Poley, J W; Fockens, P; Goggins, M G; Bruno, M J
• Is Part Of: BJS open. Volume 3:Issue 5(2019)
• Page Start: 656
• Page End: 665
• Publication Date: 2019-07-02
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50180
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating in surveillance programmes. Methods: A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter. Results: Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN, 5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality. Conclusion: A high proportion of high-risk individuals who had surgical resection for screening- or surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC at the time of surgery. Survival was better in high-risk individuals who had either low- or high-risk neoplastic precursor lesions compared with that in patients who developed PDAC. Graphical Abstract: During surveillance of high-risk individuals for pancreatic cancer, a high proportion (45 per cent) of these individuals who undergo surgical resection for screening-detected pancreatic lesions have high-risk neoplastic lesions or pancreatic cancer. Survival was best, and similar, in high-risk individuals with low-risk neoplastic lesions and those with high-risk lesions. Although all screening programmes carry the risk of overtreatment, the present results suggest that surveillance of high-risk individuals leads to the treatment of an acceptable mix of lesions. Internationally agreed protocols needed