Details

Autor(en) / Beteiligte

• Overbeek, Kasper A
• Levink, Iris J M
• Koopmann, Brechtje D M
• Harinck, Femme
• Konings, Ingrid C A W
• Ausems, Margreet G E M
• Wagner, Anja
• Fockens, Paul
• van Eijck, Casper H
• Groot Koerkamp, Bas
• Busch, Olivier R C
• Besselink, Marc G
• Bastiaansen, Barbara A J
• van Driel, Lydi M J W
• Erler, Nicole S
• Vleggaar, Frank P
• Poley, Jan-Werner
• Cahen, Djuna L
• van Hooft, Jeanin E
• Bruno, Marco J
• Bruno, M J
• Cahen, D L
• Poley, J W
• van Driel, L M J W
• Harinck, F
• Konings, I C A W
• Overbeek, K A
• Levink, I J M
• Koopmann, B D M
• Wagner, A
• Groot Koerkamp, B
• van Eijck, C H
• Biermann, K
• Peppelenbosch, M P
• Erler, N S
• Fockens, P
• van Hooft, J E
• Bastiaansen, B A J
• van der Vlugt, M
• Busch, O R
• Besselink, M G
• Ausems, M G E M
• Velthuizen, M E
• Vleggaar, F P
• van Dullemen, H
• Bleiker, E M A
• Kuenen, M A

Titel

Long-term yield of pancreatic cancer surveillance in high-risk individuals

Ist Teil von

• Gut, 2022-06, Vol.71 (6), p.1152-1160

Ort / Verlag

England: BMJ Publishing Group Ltd and British Society of Gastroenterology

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• ObjectiveWe aimed to determine the long-term yield of pancreatic cancer surveillance in hereditary predisposed high-risk individuals.DesignFrom 2006 to 2019, we prospectively enrolled asymptomatic individuals with an estimated 10% or greater lifetime risk of pancreatic ductal adenocarcinoma (PDAC) after obligatory evaluation by a clinical geneticist and genetic testing, and subjected them to annual surveillance with both endoscopic ultrasonography (EUS) and MRI/cholangiopancreatography (MRI/MRCP) at each visit.Results366 individuals (201 mutation-negative familial pancreatic cancer (FPC) kindreds and 165 PDAC susceptibility gene mutation carriers; mean age 54 years, SD 9.9) were followed for 63 months on average (SD 43.2). Ten individuals developed PDAC, of which four presented with a symptomatic interval carcinoma and six underwent resection. The cumulative PDAC incidence was 9.3% in the mutation carriers and 0% in the FPC kindreds (p<0.001). Median PDAC survival was 18 months (range 1–32). Surgery was performed in 17 individuals (4.6%), whose pathology revealed 6 PDACs (3 T1N0M0), 7 low-grade precursor lesions, 2 neuroendocrine tumours <2 cm, 1 autoimmune pancreatitis and in 1 individual no abnormality. There was no surgery-related mortality. EUS detected more solid lesions than MRI/MRCP (100% vs 22%, p<0.001), but less cystic lesions (42% vs 83%, p<0.001).ConclusionThe diagnostic yield of PDAC was substantial in established high-risk mutation carriers, but non-existent in the mutation-negative proven FPC kindreds. Nevertheless, timely identification of resectable lesions proved challenging despite the concurrent use of two imaging modalities, with EUS outperforming MRI/MRCP. Overall, surveillance by imaging yields suboptimal results with a clear need for more sensitive diagnostic markers, including biomarkers.