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Long-term PDAC screening improves detection of resectable tumours in high-risk population

22 Jun 2018

Continued follow-up study of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) leads to successful detection of resectable tumours and high-grade precursor neoplasms, as shown in a recent study.

Researchers analysed data from 354 individuals at high risk of PDAC (based on genetic factors of family history), with a median follow-up of 5.6 years. All participants underwent surveillance with endoscopic ultrasound, magnetic resonance imaging and/or computed tomography.

Main study outcome was the cumulative incidence of PDAC, grade 3 pancreatic intraepithelial neoplasia. Cox regression and Kaplan-Meier were applied in the analyses.

A total of 68 patients (19 percent) developed pancreatic lesions with worrisome features (solid mass, multiple cysts, cyst size >3 cm, thickened/enhancing walls, mural nodule, dilated main pancreatic duct >5 mm, or abrupt change in duct calibre or rapid cyst growth >4 mm/year).

Neoplastic progression occurred in 24 patients (7 percent; n=14 PDACs; n=10 high-grade dysplasias [HGDs]) over a 16-year period. The rate of progression was 1.6 percent/year, and the majority (93 percent) presented with detectable lesions with worrisome features before diagnosis of PDAC or HGD.

Of the 14 PDACs detected during routine surveillance, nine were resectable. Significantly more patients with resectable PDACs than with symptomatic, unresectable PDACs survived 3 years (85 percent vs 25 percent; p<0.0001).

Median age of patients at neoplastic progression was 67 years. Median time to PDAC diagnosis was 4.8 years (interquartile range, 1.6–6.9 years).

The findings demonstrate that continued monitoring of high-risk individuals aids in detection of resectable PDAC, researchers said. Consequently, short-term outcomes of patients with screening-detected PDACs are improved.

Large prospective studies are required to further evaluate the potential benefits of PDAC screening, they added.

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Pearl Toh, 22 Oct 2020
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