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Observational Study
. 2024 Apr 1;119(4):739-747.
doi: 10.14309/ajg.0000000000002546. Epub 2023 Oct 3.

Outcomes of a 3-Year Prospective Surveillance in Individuals at High Risk of Pancreatic Cancer

Salvatore Paiella  1 , Gabriele Capurso  2 , Silvia Carrara  3 , Erica Secchettin  4 , Fabio Casciani  1 , Isabella Frigerio  5 , Alessandro Zerbi  6   7 , Livia Archibugi  2 , Cristiana Bonifacio  8 , Giuseppe Malleo  1 , Giulia Martina Cavestro  9 , Monica Barile  10 , Alberto Larghi  11 , Daniela Assisi  12 , Alberto Fantin  13 , Anna Caterina Milanetto  14 , Carlo Fabbri  15 , Riccardo Casadei  16   17 , Giulio Donato  18 , Romano Sassatelli  19 , Giulia De Marchi  20 , Francesco Maria Di Matteo  21 , Valentina Arcangeli  22 , Francesco Panzuto  23   24 , Marta Puzzono  8 , Arianna Dal Buono  3 , Raffaele Pezzilli  25 , Roberto Salvia  1 , Gianenrico Rizzatti  11 , Marco Casadio  12 , Monica Franco  13 , Giovanni Butturini  5 , Claudio Pasquali  14 , Chiara Coluccio  15 , Claudio Ricci  16   17 , Noemi Cicchese  18 , Giuliana Sereni  19 , Nicolò de Pretis  20 , Serena Stigliano  21 , Britt Rudnas  26 , Matteo Marasco  23 , Gabriella Lionetto  1 , Paolo Giorgio Arcidiacono  2 , Maria Terrin  3 , Anna Crovetto  1 , Alessandro Mannucci  9 , Luigi Laghi  27   28 , Claudio Bassi  1 , Massimo Falconi  29
Affiliations
Observational Study

Outcomes of a 3-Year Prospective Surveillance in Individuals at High Risk of Pancreatic Cancer

Salvatore Paiella et al. Am J Gastroenterol. .

Abstract

Introduction: Pancreatic cancer (PC) surveillance of high-risk individuals (HRI) is becoming more common worldwide, aiming at anticipating PC diagnosis at a preclinical stage. In 2015, the Italian Registry of Families at Risk of Pancreatic Cancer was created. We aimed to assess the prevalence and incidence of pancreatic findings, oncological outcomes, and harms 7 years after the Italian Registry of Families at Risk of Pancreatic Cancer inception, focusing on individuals with at least a 3-year follow-up or developing events before.

Methods: HRI (subjects with a family history or mutation carriers with/without a family history were enrolled in 18 centers). They underwent annual magnetic resonance with cholangiopancreatography or endoscopic ultrasound (NCT04095195).

Results: During the study period (June 2015-September 2022), 679 individuals were enrolled. Of these, 524 (77.2%) underwent at least baseline imaging, and 156 (29.8%) with at least a 3-year follow-up or pancreatic malignancy/premalignancy-related events, and represented the study population. The median age was 51 (interquartile range 16) years. Familial PC cases accounted for 81.4% of HRI and individuals with pathogenic variant for 18.6%. Malignant (n = 8) and premalignant (1 PanIN3) lesions were found in 9 individuals. Five of these 8 cases occurred in pathogenic variant carriers, 4 in familial PC cases (2 tested negative at germline testing and 2 others were not tested). Three of the 8 PC were stage I. Five of the 8 PC were resectable, 3 Stage I, all advanced cases being prevalent. The 1-, 2-, and 3-year cumulative hazard of PC was 1.7%, 2.5%, and 3%, respectively. Median overall and disease-free survival of patients with resected PC were 18 and 12 months (95% CI not computable). Considering HRI who underwent baseline imaging, 6 pancreatic neuroendocrine neoplasms (1 resected) and 1 low-yield surgery (low-grade mixed-intraductal papillary mucinous neoplasm) were also reported.

Discussion: PC surveillance in a fully public health care system is feasible and safe, and leads to early PC or premalignant lesions diagnoses, mostly at baseline but also over time.

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References

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