Clinical features and prognostic impact of asymptomatic pancreatic cancer

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is highly lethal, and early diagnosis is challenging. Because patients who present with symptoms generally have advanced-stage diseases, analysis of asymptomatic PDAC provides invaluable information for developing strategies for early diagnosis. Here, we reviewed 577 patients with PDAC (372 diagnosed with symptoms [symptomatic group] and 205 without symptoms [asymptomatic group]) diagnosed at our institute. Among the 205 asymptomatic PDAC patients, 109 were detected during follow-up/work-up for other diseases, 61 because of new-onset or exacerbation of diabetes mellitus, and 35 in a medical check-up. Asymptomatic PDAC is characterized by smaller tumor size, earlier disease stage, and higher resectability than those of symptomatic PDAC. In 22.7% of asymptomatic cases, indirect findings, e.g., dilatation of the main pancreatic duct, triggered PDAC detection. Although pancreatic tumors were less frequently detected, overall abnormality detection rates on imaging studies were nearly 100% in asymptomatic PDAC. Asymptomatic PDAC had a better prognosis (median survival time, 881 days) than symptomatic PDAC (342 days, P < 0.001). In conclusion, diagnosis of PDAC in the asymptomatic stage is associated with early diagnosis and a better prognosis. Incidental detection of abnormal findings during the follow-up/work-up for other diseases provides important opportunities for early diagnosis of asymptomatic PDAC.

Oncogenic KRAS-Induced Protein Signature in the Tumor Secretome Identifies Laminin-C2 and Pentraxin-3 as Useful Biomarkers for the Early Diagnosis of Pancreatic Cancer

“…Considering our best candidate biomarkers, LAMC2 and PTX3, it is interesting to note that both were already significantly elevated in patients with early-stage PDAC, underscoring their potential to detect patients eligible for surgical resection, which is currently the best potentially curative medical intervention available for these patients [ 4 , 6 , 7 , 8 , 9 ]. In addition, patients with CA19-9 below the standard cutoff value of 37 U/mL had LAMC2 and PTX3 levels above the median values of healthy donors.…”

“…PDAC is characterized by early invasion into adjacent tissues and metastasis formation that hampers the possibility for surgical resection; subjects effectively eligible for surgery constitute only about 15–20% of total PDAC patients. Earlier detection of ductal adenocarcinoma is key to increase the proportion of resectable patients, surgery being the only potentially curative treatment for improving the clinical outcome [ 7 , 8 , 9 ]. Following surgery and adjuvant therapy, patient survival at 5 years increases up to 30% [ 4 , 5 , 6 , 7 ].…”

Pancreatic Incidentaloma

“…Incidental PDAC is mainly detected during other pathologies’ diagnostics or new-onset/exacerbation of diabetes mellitus evaluation. Incidentally diagnosed PDAC is characterized by smaller tumor size, higher resectability and better prognosis compared to the symptomatic PDAC [ 81 ]. The transabdominal US reveals PDAC as an irregular hypoechoic mass related to an abrupt cut-off of the MPD and upstream MPD dilatation, and sensitivity of this imaging method for the diagnosis of PDAC ranges from 75–89%, depending on numerous factors including, among others, the experience of the operator and the presence of bowel gases [ 82 , 83 ].…”

“…Data from Japan showed that 40% of asymptomatic PDAC cases were already in stage III or IV, and the 5-year overall survival was 30.6%, which is far below the average 5-year overall survival for all cancer types (64.1%) [ 81 ]. Interestingly, despite better prognosis of asymptomatic PDAC (earlier diagnosis), screening for PDAC is not actually recommended in the general population and it results from the lack of non-invasive, useful biomarkers at the early stages of disease, relatively low prevalence of PDAC and the patients’ distress associated with screening tests [ 85 , 86 ].…”

“…Interestingly, despite better prognosis of asymptomatic PDAC (earlier diagnosis), screening for PDAC is not actually recommended in the general population and it results from the lack of non-invasive, useful biomarkers at the early stages of disease, relatively low prevalence of PDAC and the patients’ distress associated with screening tests [ 85 , 86 ]. Interestingly, it is estimated that approximately 60% of the patients with incidentally diagnosed PDAC were characterized by an elevation of CA 19-9 level [ 81 ]. On the other hand, CA 19-9 could be an anchor marker for application of the pancreatic cancer early detection.…”