Long-term yield of pancreatic cancer surveillance in high-risk individuals
Open accessAbstract
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.
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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 [16]
The CAPS5 study results differ from the Dutch Familial Pancreatic Cancer Surveillance Study Group report, which had a PDAC resectability rate of only 60%, possibly due to predominance of CDKN2A mutation carriers.
“The CAPS5 study results differ in some respects from the recent report of the Dutch Familial Pancreatic Cancer Surveillance Study Group.16 This study reported a PDAC resectability rate of only 60%, which may be a function of the predominance of CDKN2A mutation carriers in their high-risk cohort”
From The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival (2022) · cites this paper as [16]
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The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival
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Self-citation
- Authors
- Overbeek, K. A., Levink, I. J. M., Koopmann, B. D. M., Harinck, F., Konings, I. C. A. W., Ausems, M. G. E. M., Wagner, A., Fockens, P., van Eijck, C. H., Groot Koerkamp, B., Busch, O. R. C., Besselink, M. G., Bastiaansen, B. A. J., van Driel, L. M. J. W., Erler, N. S., Vleggaar, F. P., Poley, J.-W., Cahen, D. L., van Hooft, J. E., & Bruno, M. J.
- Affiliations
- Erasmus MC (NL)
- University Medical Center Utrecht (NL)
- Amsterdam University Medical Centers (NL)
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Corresponding author
- Overbeek, Kasper A
- ORCID
- 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
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2021-04-05
- Volume
- 71
- Issue
- 6
- Pages
- 1152-1160
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC9120399
- OpenAlex
- W3150102863
- Cited by
- 164
- References
- 45
- Citations by year
- 2026: 18 · 2025: 21 · 2024: 38 · 2023: 45 · 2022: 31 · 2021: 11
- FWCI
- 11.46
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Gut (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
- Leiden Repository (Leiden University) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- Funders
- Kom in beweging tegen alvleesklierkanker (charity donation)
- ZonMw (120520016)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Keywords
- pancreatic ductal adenocarcinoma, cancer surveillance, hereditary pancreatic cancer, endoscopic ultrasound, diagnostic yield, early detection, pancreatic cysts, pancreatic neuroendocrine tumors, autoimmune pancreatitis, pancreatic cancer biomarkers
- MeSH terms
- Carcinoma, Humans, Middle Aged, Pancreatic Neoplasms, Carcinoma, Pancreatic Ductal, Early Detection of Cancer
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