Predictive Factors for Pancreatic Cancer and Its Early Detection Using Special Pancreatic Ultrasonography in High-Risk Individuals

SIMPLE SUMMARY: The early detection of pancreatic cancer is required to improve prognosis. We aimed to analyze the predictive factors of neoplastic progression in patients at high risk for pancreatic cancer and examined the efficiency of surveillance using transabdominal special ultrasonography focusing on the pancreas (special pancreatic US). On long-term surveillance with special pancreatic US of 498 patients who had main pancreatic duct (MPD) dilatation (≥2.5 mm) and/or pancreatic cysts (≥5 mm), neoplastic progression developed in 11 patients (2.2%). Findings of both MPD dilatation and pancreatic cysts, MPD growth (≥0.2 mm/year) and cyst growth (≥2 mm/year) during surveillance were risk factors for neoplastic progression. Periodic surveillance using special pancreatic US allowed the early diagnosis of neoplastic progression (stage 0/I: 72.7%), leading to a favorable prognosis (overall survival: 8.8 years). This study clarified the efficiency of surveillance with special pancreatic US for high-risk individuals and key changes during surveillance to watch for. ABSTRACT: Because pancreatic cancer has a dismal prognosis, a strategy for early diagnosis is required. This study aimed to identify predictive factors of neoplastic progression in patients at high risk for pancreatic cancer and examined the efficiency of surveillance using transabdominal special ultrasonography focusing on the pancreas (special pancreatic US). Patients with slight main pancreatic duct (MPD) dilatation (≥2.5 mm) and/or pancreatic cysts (≥5 mm) were enrolled in a prospective surveillance study with special pancreatic US in a Japanese cancer referral center. A total of 498 patients undergoing surveillance for ≥3 years were included. During the median follow-up of 5.9 years, neoplastic progression developed in 11 patients (2.2%), including 9 patients who underwent pancreatectomy. Eight patients (72.7%) were diagnosed with stage 0/I disease, with an overall survival duration of 8.8 years. Findings of both MPD dilatation and pancreatic cysts at initial surveillance, MPD growth (≥0.2 mm/year) and cyst growth (≥2 mm/year) during surveillance were identified as independent risk factors for neoplastic progression. In summary, surveillance with special pancreatic US for high-risk individuals contributed to earlier detection of neoplastic progression, leading to a favorable prognosis. During surveillance, attention should be paid to MPD growth as well as to cyst growth.