Surveillance for pancreatic cancer in high-risk individuals

被引：23

作者：

Konings, I. C. A. W. ^{[1
]}

Canto, M., I ^{[3
]}

Almario, J. A. ^{[3
]}

Harinck, E. ^{[1
]}

Saxena, P. ^{[3
,11
]}

Lucas, A. L. ^{[5
]}

Kastrinos, E. ^{[6
]}

Whitcomb, D. C. ^{[7
]}

Brand, R. E. ^{[7
]}

Lachter, J. ^{[12
]}

Malleo, G. ^{[13
]}

Paiella, S. ^{[13
]}

Syngal, S. ^{[8
,9
]}

Saltzman, J. R. ^{[8
,9
]}

Stoffel, E. M. ^{[10
]}

van Hooft, J. E. ^{[2
]}

Hruban, R. H. ^{[4
]}

Poley, J. W. ^{[1
]}

Fockens, P. ^{[2
]}

Goggins, M. G. ^{[3
]}

Bruno, M. J. ^{[1
]}

机构：

[1] Univ Med Ctr Rotterdam, Erasmus MC, iDept Gastroenterol & Hepatol, Rotterdam, Netherlands

[2] Univ Amsterdam, Acad Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[3] Johns Hopkins Med Inst, Dept Gastroenterol & Hepatol, Baltimore, MD 21205 USA

[4] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Pathol, Baltimore, MD 21205 USA

[5] Icahn Sch Med Mt Sinai, Div Gastroenterol, New York, NY 10029 USA

[6] Columbia Univ, Med Ctr, Div Digest & Liver Dis, New York, NY USA

[7] Univ Pittsburgh, Sch Med, Div Gastroenterol Hepatol & Nutr, Pittsburgh, PA USA

[8] Brigham & Womens Hosp, Dept Gastroenterol, 75 Francis St, Boston, MA 02115 USA

[9] Dana Farber Canc Inst, Populat Sci Div, Boston, MA 02115 USA

[10] Univ Michigan, Dept Internal Med, Ann Arbor, MI 48109 USA

[11] Royal Prince Alfred Hosp, Dept Gastroenterol & Hepatol, Camperdown, NSW, Australia

[12] Rambam Healthcare Campus, Dept Gastroenterol, Haifa, Israel

[13] Univ Hosp Verona, Dept Gen Surg, Verona, Italy

来源：

BJS OPEN | 2019年 / 3卷 / 05期

关键词：

PRECURSOR LESIONS; RESECTION; COHORT; YIELD;

D O I：

10.1002/bjs5.50180

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating in surveillance programmes. Methods A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter. Results Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN, 5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality. Conclusion A high proportion of high-risk individuals who had surgical resection for screening- or surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC at the time of surgery. Survival was better in high-risk individuals who had either low- or high-risk neoplastic precursor lesions compared with that in patients who developed PDAC.

引用

页码：656 / 665

页数：10

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