Canto MI, et al. - Authors assessed the incidence of pancreatic ductal adenocarcinoma (PDAC) and risk factors for neoplastic progression in individuals at high risk for PDAC enrolled in a long-term screening study. Findings of a long-term (16-year) follow-up study of individuals at high-risk for PDAC suggested resectability of most PDACs detected during surveillance (9/10), and 85% of these patients to survive for 3 years. Radiologic features associated with neoplastic progression were identified.

Methods

• Researchers evaluated the data from 354 individuals at high risk for PDAC (based on genetic factors of family history), enrolled in Cancer of the Pancreas Screening cohort studies at tertiary care academic centers from 1998 through 2014 (median follow-up time, 5.6 years).
• They assessed all subjects at study entry (baseline) by endoscopic ultrasound and underwent surveillance with endoscopic ultrasound, magnetic resonance imaging, and/or computed tomography.
• The cumulative incidence of PDAC, pancreatic intraepithelial neoplasia grade 3, or intraductal papillary mucinous neoplasm with high-grade dysplasia (HGD) after baseline was the primary endpoint.
• Multivariate Cox regression and Kaplan-Meier analyses were performed.

Results

• As per data, during the follow-up period, 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 caliber) or rapid cyst growth (>4 mm/year) were detected in 68 patients (19%).
• Findings suggested that neoplastic progression (14 PDACs and 10 HGDs) over a 16-year period was seen in overall, 24/354 patients (7%); the rate of progression was 1.6%/year and 93% had detectable lesions with worrisome features before diagnosis of the PDAC or HGD.
• Results demonstrated that 9 of the 10 PDACs detected during routine surveillance, were resectable.
• Experts noted that a significantly higher proportion of patients with resectable PDACs survived 3 years (85%) vs the 4 subjects with symptomatic, unresectable PDACs (25%), which developed outside surveillance (log rank P < .0001).
• At a median age of 67 years, neoplastic progression occurred.
• From baseline screening until PDAC diagnosis the median time was 4.8 years (inter-quartile range, 1.6–6.9 years).