Pancreatic Cancer Surveillance in People at High Risk Not Tied to Better Outcomes

By David Douglas

April 16, 2021

NEW YORK (Reuters Health) - Surveillance of people at high hereditary risk for pancreatic ductal adenocarcinoma (PDAC) can lead to diagnosis at an earlier stage, but as yet there is no clear survival benefit, according to researchers in the Netherlands.

Dr. Kasper A. Overbeek of Erasmus University Medical Center, in Rotterdam, and colleagues followed 366 asymptomatic individuals (mean age, 54) with an estimated 10% or greater lifetime risk of PDAC; 201 were mutation-negative familial pancreatic cancer (FPC) kindreds and the remaining 165 were PDAC-susceptibility-gene-mutation carriers.

Annual surveillance involved both endoscopic ultrasonography and MRI/magnetic resonance cholangiopancreatography (MRCP) at each visit.

"In this surveillance program spanning thirteen years, pancreatic cancer developed in 9.3% of individuals with a proven mutation in a pancreatic-cancer-susceptibility gene," Dr. Overbeek told Reuters Health by email. "The risk was especially high for those with a CDKN2A gene mutation or the Peutz-Jeghers syndrome."

The high PDAC incidence within these groups, he and his colleagues write, "support the recommendation that these specific mutation carriers are favorable candidates for surveillance."

However, continued Dr. Overbeek, "Contrary to what was expected, no pancreatic cancer was detected in the individuals with a family history of pancreatic cancer but without any of the known genetic mutations."

Of 10 patients who developed PDAC, six had resectable cancers, of which three were diagnosed at an early stage. There was no surgery-related mortality. The other four presented as symptomatic metastasized interval carcinomas.

The median survival of patients with PDAC was 18 months, the researchers report in Gut.

The team found that endoscopic ultrasonography detected more solid lesions than MRI/MRCP, and the latter did not add relevant diagnostic value. Still, "timely identification of resectable lesions proved challenging," they write, and more sensitive diagnostic markers are needed.

Overall, concluded Dr. Overbeek, "We did not find convincing evidence that surveillance truly leads to better outcomes of pancreatic cancer. Compared to cases with sporadic pancreatic cancer, high-risk individuals participating in the surveillance study had earlier-stage pancreatic cancer, could undergo a potentially curative surgical resection more often and seemed to survive somewhat longer, but due to the nature of this surveillance study and the lack of a control group, these results may have been affected by lead-time bias."

Dr. Joe Hines of the University of California, Los Angeles, who was not involved in the study, told Reuters Health by email, "The genetics of pancreatic cancer are beginning to impact the clinical recommendations for diagnosis and treatment."

"This study validates the concept of screening for patients who are higher risk for this condition and with time this approach will result in better outcomes and longer survival," said Dr. Hines, director of the UCLA Agi Hirshberg Center for Pancreatic Disease.

SOURCE: Gut, online April 5, 2021.