Results of First-Round of Surveillance in Individuals at High-Risk of Pancreatic Cancer from the AISP (Italian Association for the Study of the Pancreas) Registry

Abstract

INTRODUCTION: Surveillance programs on high-risk individuals (HRIs) can detect pre-malignant lesions or early pancreatic cancer (PC). We report the results of the first screening round of the Italian multicenter program supported by the Italian Association for the study of the Pancreas (AISP). METHODS: The multicenter surveillance program included asymptomatic HRIs with familial (FPC) or genetic frailty (GS: BRCA1/2, p16/CDKN2A, STK11/LKB1or PRSS1, mutated genes) predisposition to PC. The surveillance program included at least an annual magnetic resonance cholangio pancreatography (MRCP). Endoscopic ultrasound (EUS) was proposed to patients who refused or could not be submitted to MRCP. RESULTS: One-hundreds eighty-seven HRIs underwent a first-round screening examination with MRCP (174; 93.1%) or EUS (13; 6.9%) from September 2015 to March 2018.The mean age was 51 years (range 21–80).One-hundreds sixty-five (88.2%) FPC and 22 (11.8%) GF HRIs were included. MRCP detected 28 (14.9%) presumed branch-duct intraductal papillary mucinous neoplasms (IPMN), 1 invasive carcinoma/IPMN and one low-grade mixed-type IPMN, respectively. EUS detected 4 PC (2.1%): 1 was resected, 1 was found locally advanced intraoperatively, and 2 were metastatic. Age > 50 (OR 3.3, 95%CI 1.4–8), smoking habit (OR 2.8, 95%CI 1.1–7.5), and having > 2 relatives with PC (OR 2.7, 95%CI 1.1–6.4) were independently associated with detection of pre-malignant and malignant lesions. The diagnostic yield for MRCP/EUS was 24% for cystic lesions. The overall rate of surgery was 2.6% with nil mortality. DISCUSSION: The rate of malignancies found in this cohort was high (2.6%). According to the International Cancer of the Pancreas Screening Consortium the screening goal achievement was high (1%).

Diagnostic delay does not influence survival of pancreatic cancer patients

“…4 This is mainly due to the fact that most patients present with advanced disease not amenable to surgical resection, which remains the only potentially curative treatment. 5 Indeed, outside of screening programmes that are currently limited to research protocols conducted on small populations of high-risk individuals, 6,7 the disease is usually diagnosed as a result of signs and symptoms that are often unspecific and unrecognised, possibly determining diagnostic delay. The key question concerning early detection is whether or not it is possible to increase survival by identifying those patients whose complaints and risk factors suggest a diagnosis of PDAC.…”

The emotional impact of surveillance programs for pancreatic cancer on high‐risk individuals: A prospective analysis

“…The surveillance program workflow has been already reported . At the first scheduled appointment, inclusion and exclusion criteria are considered prior to enrollment.…”

Surveillance for individuals at high‐risk of pancreatic cancer: Are we finally heading toward evidence?

“…Paiella et al reported data of the first round of surveillance of HRIs in the Italian Association for the Study of the Pancreas Registry. 5 The rate of malignancy in the 187 enrolled HRIs was 2.6%, and age older than 50 years, smoking and having more than two relatives with PDAC were independently associated with detection of premalignant and malignant lesions. Finally, Canto and colleagues 6 investigated the incidence of PDAC in 354 HRIs with a median follow-up of more than five years undergoing surveillance in the CAPS (Cancer of the Pancreas Screening) studies in the United States.…”