Surveillance for pancreatic cancer in high‐risk individuals
I. C. A. W. Konings,
M. I. Canto,
J. A. Almario,
F. Harinck,
P. Saxena,
A. L. Lucas,
F. Kastrinos,
D. C. Whitcomb,
R. E. Brand,
J. Lachter,
G. Malleo,
S. Paiella,
S. Syngal,
J. R. Saltzman,
E. M. Stoffel,
J. E. vanHooft,
R. H. Hruban,
J. W. Poley,
P. Fockens,
M. G. Goggins,
M. J. Bruno,
on behalf of the International CAncer of the Pancreas Screening (CAPS) Consortium
Affiliations
I. C. A. W. Konings
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
M. I. Canto
Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
J. A. Almario
Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
F. Harinck
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
P. Saxena
Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
A. L. Lucas
Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
F. Kastrinos
Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, USA
D. C. Whitcomb
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
R. E. Brand
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
J. Lachter
Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
G. Malleo
Department of General Surgery, University Hospital of Verona, Verona, Italy
S. Paiella
Department of General Surgery, University Hospital of Verona, Verona, Italy
S. Syngal
Department of Gastroenterology, Brigham and Women's Hospital and Population Sciences Division, Dana Farber Cancer Institute, Boston, Massachusetts, USA
J. R. Saltzman
Department of Gastroenterology, Brigham and Women's Hospital and Population Sciences Division, Dana Farber Cancer Institute, Boston, Massachusetts, USA
E. M. Stoffel
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
J. E. vanHooft
Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
R. H. Hruban
Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland
J. W. Poley
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
P. Fockens
Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
M. G. Goggins
Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
M. J. Bruno
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
on behalf of the International CAncer of the Pancreas Screening (CAPS) Consortium
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.
