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

doi:10.1002/bjs5.50180

BJS Open (Oct 2019)

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

DOI: https://doi.org/10.1002/bjs5.50180
Journal volume & issue: Vol. 3, no. 5
pp. 656 – 665

Abstract

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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.

Published in BJS Open

ISSN: 2474-9842 (Online)
Publisher: Oxford University Press
Country of publisher: United Kingdom
LCC subjects: Medicine: Surgery
Website: https://academic.oup.com/bjsopen

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