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

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 (PD...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120399/
https://www.ncbi.nlm.nih.gov/pubmed/33820756
http://dx.doi.org/10.1136/gutjnl-2020-323611
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author 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
author_facet 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
author_sort Overbeek, Kasper A
collection PubMed
description 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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spelling pubmed-91203992022-06-04 Long-term yield of pancreatic cancer surveillance in high-risk individuals 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 Gut Pancreas 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. BMJ Publishing Group 2022-06 2021-04-05 /pmc/articles/PMC9120399/ /pubmed/33820756 http://dx.doi.org/10.1136/gutjnl-2020-323611 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Pancreas
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
Long-term yield of pancreatic cancer surveillance in high-risk individuals
title Long-term yield of pancreatic cancer surveillance in high-risk individuals
title_full Long-term yield of pancreatic cancer surveillance in high-risk individuals
title_fullStr Long-term yield of pancreatic cancer surveillance in high-risk individuals
title_full_unstemmed Long-term yield of pancreatic cancer surveillance in high-risk individuals
title_short Long-term yield of pancreatic cancer surveillance in high-risk individuals
title_sort long-term yield of pancreatic cancer surveillance in high-risk individuals
topic Pancreas
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120399/
https://www.ncbi.nlm.nih.gov/pubmed/33820756
http://dx.doi.org/10.1136/gutjnl-2020-323611
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