Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals
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BACKGROUND & AIMS: To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection. METHODS: We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs. RESULTS: Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7-57 mm), a median of 11 months (IQR, 8; range 3-17 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525-19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812-0.976/mm). CONCLUSIONS: In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed.
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Recent evidence indicates that pancreas surveillance can downstage pancreatic cancers diagnosed in high-risk individuals, though based on few studies.
“Recent evidence indicates that pancreas surveillance can downstage pancreatic cancers diagnosed in high-risk individuals (HRIs), although this is based upon only a few studies,12,14-16 with relatively few PDACs diagnosed, and only a small percentage of which were diagnosed with stage I disease.17”
From The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival (2022) · cites this paper as [17]
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- Authors
- Overbeek, K. A., Goggins, M. G., Dbouk, M., Levink, I. J. M., Koopmann, B. D. M., Chuidian, M., Konings, I. C. A. W., Paiella, S., Earl, J., Fockens, P., Gress, T. M., Ausems, M. G. E. M., Poley, J.-W., Thosani, N. C., Half, E., Lachter, J., Stoffel, E. M., Kwon, R. S., Stoita, A., Kastrinos, F., Lucas, A. L., Syngal, S., Brand, R. E., Chak, A., Carrato, A., Vleggaar, F. P., Bartsch, D. K., van Hooft, J. E., Cahen, D. L., Canto, M. I., & Bruno, M. J.
- Affiliations
- Erasmus MC (NL)
- Johns Hopkins University (US)
- University of Verona (IT)
- Instituto Ramón y Cajal de Investigación Sanitaria (ES)
- Amsterdam University Medical Centers (NL)
- Philipps University of Marburg (DE)
- University Medical Center Utrecht (NL)
- The University of Texas Health Science Center at Houston (US)
- Rambam Health Care Campus (IL)
- University of Michigan (US)
- UNSW Sydney (AU)
- Columbia University Irving Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
- Brigham and Women's Hospital (US)
- University of Pittsburgh Medical Center (US)
- University Hospitals of Cleveland (US)
- Universidad de Alcalá (ES)
- Corresponding author
- Overbeek, Kasper A.
- ORCID
- Overbeek, Kasper A.
- Goggins, Michael G.
- Dbouk, Mohamad
- Levink, Iris J.M.
- Koopmann, Brechtje D.M.
- Konings, Ingrid C.A.W.
- Paiella, Salvatore
- Earl, Julie
- Fockens, Paul
- Gress, Thomas M.
- Ausems, Margreet G.E.M.
- Poley, Jan-Werner
- Thosani, Nirav C.
- Half, Elizabeth
- Lachter, Jesse
- Stoffel, Elena M.
- Kwon, Richard S.
- Stoita, Alina
- Kastrinos, Fay
- Lucas, Aimee L.
- Syngal, Sapna
- Brand, Randall E.
- Chak, Amitabh
- Carrato, Alfredo
- Vleggaar, Frank P.
- Bartsch, Detlef K.
- Cahen, Djuna L.
- Canto, Marcia Irene
- Bruno, Marco J.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2022-03
- Volume
- 162
- Issue
- 3
- Pages
- 772-785.e4
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W3205562473
- Cited by
- 114
- References
- 34
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 32 · 2023: 32 · 2022: 21 · 2021: 1
- FWCI
- 7.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Gastroenterology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by-nc-nd)
- Leiden Repository (Leiden University) (submittedVersion, cc-by-nc-nd)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Funders
- Celgene
- Bayer
- Shire
- AbbVie
- Medtronic
- Cook Medical
- Hope Foundation
- Abbott Laboratories
- Boston Scientific Japan
- Ethicon Endo-Surgery
- Myriad Genetics
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Keywords
- pancreatic cancer, tumor progression, high-grade dysplasia, pancreatic cysts, early detection, high-risk individuals, lesion growth rate, serial imaging
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasm Metastasis, Pancreas, Pancreatic Cyst, Pancreatic Neoplasms, Precancerous Conditions, Retrospective Studies, Risk Factors, Time Factors, Tomography, X-Ray Computed, Disease Progression, Endosonography, Tumor Burden, Early Detection of Cancer, Watchful Waiting
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