Clear need for sensitive diagnostic markers for pancreatic cancer surveillance
The diagnostic yield of pancreatic ductal adenocarcinoma was substantial in high-risk mutation carrier but non-existent in mutation-negative proven familial pancreatic cancer kindreds.
“Nevertheless, timely identification of resectable lesions proved challenging despite the concurrent use of two imaging modalities, with [endoscopic ultrasonography (EUS)] outperforming [MRI/cholangiopancreatography (MRI/MRCP)],” Kasper A. Overbeek, MD, from the department of gastroenterology and hepatology and the Erasmus MC Cancer Institute, Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues wrote. “Overall, surveillance by imaging yields suboptimal results with a clear need for more sensitive diagnostic markers, including biomarkers.”
Overbeek and colleagues enrolled asymptomatic patients with an estimated 10% or greater lifetime risk for pancreatic ductal adenocarcinoma. They identified 366 patients, 201 with mutation-negative familial pancreatic cancer kindreds and 165 pancreatic ductal adenocarcinoma (PDAC) susceptibility gene mutation carriers.
A clinical geneticist evaluated the patients, who underwent annual surveillance with both endoscopic ultrasonography and MRI/MRCP at each visit. Average follow-up was 63 months.
Ten patients developed PDAC; four presented with symptomatic interval carcinoma and six underwent resection. In mutation carriers, cumulative PDAC incidence was 9.3% and 0% in the familial pancreatic cancer kindreds (P < .001). Median PDAC survival was 18 months.
“Surgery was performed in 17 individuals (4.6%), whose pathology revealed six PDACs (3 T1N0M0), seven low-grade precursor lesions, two neuroendocrine tumors [less than] 2 cm, one autoimmune pancreatitis and in one individual no abnormality,” the researchers wrote.
According to Overbeek and colleauges, there was no surgery-related mortality. The EUS vs. the MRI/MRCP detected more solid lesions (100% vs 22%; P < .001); however, detected less cystic lesions (42% vs 83%; P < .001).