Pancreatic Cancer Surveillance Supported For High-Risk Mutation Carriers

High-risk mutation carriers may benefit from regular imaging for pancreatic ductal adenocarcinoma

medwireNews: Individuals carrying the p16-Leiden or CDKN2A mutations associated with a high risk of pancreatic ductal adenocarcinoma (PDAC) benefit from regular imaging, suggests research published in the Journal of Clinical Oncology.

Hans Vasen, from Leiden University Medical Center in the Netherlands, and co-authors, report that surveillance of such patients is “relatively successful, detecting most PDACs at a resectable stage.”

Of the 178 patients positive for the p16-Leiden or CDKN2A mutations who underwent annual magnetic resonance (MR) imaging, MR cholangiopancreatography and/or endoscopic ultrasound for an average of 53 months, 7.3% were diagnosed with PDAC and two (0.9%) had low-risk precursor lesions.

In all, 75% of these patients underwent surgery and the 5-year survival rate was 24%. These rates are “much higher” than historical resection rates of around 15% for both CDKN2A carriers and patients with sporadic PDAC, and 5-year survival rates of 4–7% for symptomatic sporadic PDAC, the researchers say.

Fourteen patients would require screening, with 67 MR imaging sessions, to detect one case of PDAC, the researchers note.

While acknowledging it is difficult to determine benefit with certainty without a control group, they believe that the outcomes for p16-Leiden/CDKN2A carriers translate to improved prognosis, an important criterion for surveillance.

However, after an average of 2.8 years of screening, the authors found the benefit of surveillance in a group of 214 patients with familial pancreatic cancer (FPC) to be “less evident”, with a low yield of PDAC and precursor lesions.

Just three (1.4%) patients had lesions suspicious for PDAC, with investigation confirming cancer in one case, and revealing a benign cystadenoma and a grade 2 neuroendocrine tumour in the other patients.

A further 6.1% of patients underwent surgery for suspicious cystic precursor lesions, with histology identifying four high-risk lesions and four multifocal grade 2 lesions, three serious cystadenomas and two cases of focal fibrosis. Five (2.3%) individuals at risk were considered to be overtreated.

“The value of surveillance of FPC is still not clear, and the main effect seems to be prevention of PDAC by removal of [precursor lesions]”, the team concludes.

Reference

Vasen H, Ibrahim I, Ponce CG, et al. Benefit of surveillance for pancreatic cancer in high-risk individuals: Outcome of long-term prospective follow-up studies from three European expert centers. J Clin Oncol 2016; Advance online publication 25 April. doi: 10.1200/JCO.2015.64.0730

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