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Benefit of Surveillance for Pancreatic Cancer in High-Risk Individuals: Outcome of Long-Term Prospective Follow-Up Studies From Three European Expert Centers.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2016 Jun 10; Vol. 34 (17), pp. 2010-9. Date of Electronic Publication: 2016 Apr 25. - Publication Year :
- 2016
-
Abstract
- Purpose: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis. Hereditary factors play a role in the development of PDAC in 3% to 5% of all patients. Surveillance of high-risk groups, may facilitate detection of PDAC at an early stage. The aim of this study was to assess whether surveillance aids detection of early-stage PDAC or precursor lesions (PRLs) and improves the prognosis.<br />Patients and Methods: Screening outcomes were collected from three European centers that conduct prospective screening in high-risk groups including families with clustering of PDAC (familial pancreatic cancer [FPC]) or families with a gene defect that predisposes to PDAC. The surveillance program consisted of annual magnetic resonance imaging, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound.<br />Results: Four hundred eleven asymptomatic individuals participated in the surveillance programs, including 178 CDKN2A mutation carriers, 214 individuals with FPC, and 19 BRCA1/2 or PALB2 mutation carriers. PDAC was detected in 13 (7.3%) of 178 CDKN2A mutation carriers. The resection rate was 75%, and the 5-year survival rate was 24%. Two CDKN2A mutation carriers (1%) underwent surgical resection for low-risk PRL. Two individuals (0.9%) in the FPC cohort had a pancreatic tumor, including one advanced PDAC and one early grade 2 neuroendocrine tumor. Thirteen individuals with FPC (6.1%) underwent surgical resection for a suspected PRL, but only four (1.9%) had high-risk lesions (ie, high-grade intraductal papillary mucinous neoplasms or grade 3 pancreatic intraepithelial neoplasms). One BRCA2 mutation carrier was found to have PDAC, and another BRCA2 mutation carrier and a PALB2 mutation carrier underwent surgery and were found to have low-risk PRL. No serious complications occurred as consequence of the program.<br />Conclusion: Surveillance of CDNK2A mutation carriers is relatively successful, detecting most PDACs at a resectable stage. The benefit of surveillance in families with FPC is less evident.<br /> (© 2016 by American Society of Clinical Oncology.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal diagnostic imaging
Carcinoma, Pancreatic Ductal genetics
Carcinoma, Pancreatic Ductal pathology
Cyclin-Dependent Kinase Inhibitor p16 genetics
Early Detection of Cancer
Follow-Up Studies
Genetic Predisposition to Disease
Humans
Magnetic Resonance Imaging
Middle Aged
Mutation
Pancreatic Neoplasms diagnostic imaging
Pancreatic Neoplasms genetics
Pancreatic Neoplasms pathology
Prospective Studies
Risk Factors
Carcinoma, Pancreatic Ductal diagnosis
Pancreatic Neoplasms diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 34
- Issue :
- 17
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 27114589
- Full Text :
- https://doi.org/10.1200/JCO.2015.64.0730