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

• Published in: Gut Vol. 71; no. 6; pp. 1152 - 1160
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Society of Gastroenterology 01.06.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adenocarcinoma; Age; Anesthesia; Asymptomatic; Biomarkers; Carcinoma; Carcinoma, Pancreatic Ductal - diagnosis; Carcinoma, Pancreatic Ductal - epidemiology; Carcinoma, Pancreatic Ductal - genetics; Early Detection of Cancer - methods; endoscopic ultrasonography; Endoscopy; family cancer; Family medical history; Genetic screening; Humans; Lesions; Magnetic resonance imaging; Medical prognosis; Middle Aged; Mortality; Mutation; Neuroendocrine tumors; Pancreas; Pancreatic cancer; Pancreatic Neoplasms; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - genetics; Pancreatitis; Point mutation; Statistical analysis; Surgery; Surveillance; Ultrasonic imaging; Netherlands; magnetic resonance imaging; pancreatic cancer; endoscopic ultrasonography; surveillance; family cancer
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2020-323611

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.