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

Kasper A. Overbeek*, Iris J.M. Levink, Brechtje D.M. Koopmann, Femme Harinck, Ingrid C.A.W. Konings, Margreet G.E.M. Ausems, Anja Wagner, Paul Fockens, Casper H. Van Eijck, Bas Groot Koerkamp, Olivier R.C. Busch, Marc G. Besselink, Barbara A.J. Bastiaansen, Lydi M.J.W. Van Driel, Nicole S. Erler, Frank P. Vleggaar, Jan Werner Poley, Djuna L. Cahen, Jeanin E. Van Hooft, Marco J. Bruno

*Corresponding author for this work

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Abstract

Objective We aimed to determine the long-term yield of pancreatic cancer surveillance in hereditary predisposed high-risk individuals. Design From 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. Results 366 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). Conclusion The 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.

Original languageEnglish
Pages (from-to)1152-1160
Number of pages9
JournalGut
Volume71
Issue number6
DOIs
Publication statusPublished - 1 Jun 2022

Bibliographical note

Funding Information:
consultant to Olympus, Cook Medical and Ethicon Endosurgery. JWP is a consultant to Boston Scientific, Cook Medical and Pentax Medical. DLC is a consultant to Tramedico. JEH received research funding from Abbott and Cook Medical. She is a consultant to Boston Scientific, Cook Medical and Medtronics. MJB received research funding from Boston Scientific, Cook Medical and Pentax Medical. He is a consultant to Boston Scientific, Cook Medical, Pentax Medical and Mylan. The other authors have nothing to disclose.

Funding Information:
Funding This study was partly funded by a grant from ZonMW (120520016) and a charity donation from ’Kom in beweging tegen alvleesklierkanker’. There was no commercial funding.

Publisher Copyright:
© 2022 Author(s) (or their employer(s)). Re-use permitted under CC BY. Published by BMJ.

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