Surveillance imaging in individuals at high-risk for pancreatic cancer: Not a ceiling, but rather a floor upon which to build

Background: We performed a critical overview of published systematic reviews (SRs) of chemotherapy for advanced and locally advanced pancreatic cancer, and evaluated their quality using AMSTAR2 and ROBIS tools. Materials and Methods: PubMed and Cochrane Central Library were searched for SRs on 13th June 2020. SRs with metaanalysis which included only randomized controlled trials and that had assessed chemotherapy as one of the treatment arms were included. The outcome measures, which were looked into, were progression-free survival (PFS), overall survival (OS), and adverse events (AEs) of grade 3 or above. Two reviewers independently assessed all the SRs with both ROBIS and AMSTAR2. Results: Out of the 1,879 identified records, 26 SRs were included for the overview. Most SRs had concluded that gemcitabine-based combination regimes, prolonged OS and PFS, but increased the incidence of grade 3-4 toxicities, when compared to gemcitabine monotherapy, but survival benefits were not consistent when gemcitabine was combined with molecular targeted agents. As per ROBIS, 24/26 SRs had high risk of bias, with only 1/26 SR having low risk of bias. As per AMSTAR2, 25/26 SRs had critically low, and 1/26 SR had low, confidence in the results. The study which scored ‘low’ risk of bias in ROBIS scored ‘low confidence in results’ in AMSTAR2. The inter-rater reliability for scoring the overall confidence in the SRs with AMSTAR2 and the overall domain in ROBIS was substantial; ROBIS: kappa=0.785, SEM=0.207, p<0.001; AMSTAR2: kappa=0.649, SEM=0.323, p<0.001. Conclusion: Gemcitabine-based combination regimens can prolong OS and PFS but also worsen AEs when compared to gemcitabine monotherapy. The included SRs have an overall low methodological quality and high risk of bias as per AMSTAR2 and ROBIS respectively.

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Possibility of detecting intraductal papillary mucinous neoplasms using metabolite biomarkers for pancreatic cancer

Biomarkers in Medicine ◽

10.2217/bmm-2019-0587 ◽

2020 ◽

Vol 14 (11) ◽

pp. 1009-1020

Author(s):

Ryota Nakano ◽

Shin Nishiumi ◽

Takashi Kobayashi ◽

Takuya Ikegawa ◽

Yuzo Kodama ◽

...

Keyword(s):

Pancreatic Cancer ◽

High Risk ◽

Multiple Logistic Regression Analysis ◽

High Sensitivity ◽

Plasma Samples ◽

Multiple Logistic Regression ◽

Intraductal Papillary Mucinous Neoplasms ◽

Detection Model ◽

High Risk Factors ◽

Mucinous Neoplasms

Aim: The aim of this study was to identify whether metabolite biomarker candidates for pancreatic cancer (PC) could aid detection of intraductal papillary mucinous neoplasms (IPMN), recognized as high-risk factors for PC. Materials & methods: The 12 metabolite biomarker candidates, which were found to be useful to detect PC in our previous study, were evaluated for plasma samples from patients with PC (n = 44) or IPMN (n = 24) or healthy volunteers (n = 46). Results: Regarding the performance of individual biomarkers of PC and PC high-risk IPMN, lysine exhibited the best performance (sensitivity: 67.8%; specificity: 86.9%). The multiple logistic regression analysis-based detection model displayed high sensitivity and specificity values of 92.5 and 90.6%, respectively. Conclusion: Metabolite biomarker candidates for PC are useful for detecting high-risk IPMN, which can progress to PC.

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Predictive Factors for Pancreatic Cancer and Its Early Detection Using Special Pancreatic Ultrasonography in High-Risk Individuals

Cancers ◽

10.3390/cancers13030502 ◽

2021 ◽

Vol 13 (3) ◽

pp. 502

Author(s):

Junko Fukuda ◽

Kenji Ikezawa ◽

Miho Nakao ◽

Suetsumi Okagaki ◽

Reiko Ashida ◽

...

Keyword(s):

Pancreatic Cancer ◽

High Risk ◽

Predictive Factors ◽

Survival Duration ◽

Pancreatic Cysts ◽

Neoplastic Progression ◽

Dismal Prognosis ◽

Independent Risk Factors ◽

Cyst Growth

Because pancreatic cancer has a dismal prognosis, a strategy for early diagnosis is required. This study aimed to identify predictive factors of neoplastic progression in patients at high risk for pancreatic cancer and examined the efficiency of surveillance using transabdominal special ultrasonography focusing on the pancreas (special pancreatic US). Patients with slight main pancreatic duct (MPD) dilatation (≥2.5 mm) and/or pancreatic cysts (≥5 mm) were enrolled in a prospective surveillance study with special pancreatic US in a Japanese cancer referral center. A total of 498 patients undergoing surveillance for ≥3 years were included. During the median follow-up of 5.9 years, neoplastic progression developed in 11 patients (2.2%), including 9 patients who underwent pancreatectomy. Eight patients (72.7%) were diagnosed with stage 0/I disease, with an overall survival duration of 8.8 years. Findings of both MPD dilatation and pancreatic cysts at initial surveillance, MPD growth (≥0.2 mm/year) and cyst growth (≥2 mm/year) during surveillance were identified as independent risk factors for neoplastic progression. In summary, surveillance with special pancreatic US for high-risk individuals contributed to earlier detection of neoplastic progression, leading to a favorable prognosis. During surveillance, attention should be paid to MPD growth as well as to cyst growth.

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Sa1365 – Patient-Reported Burden of Intensified Surveillance and Surgery in High-Risk Individuals Under Pancreatic Cancer Surveillance

Gastroenterology ◽

10.1016/s0016-5085(19)37652-8 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-328

Author(s):

Kasper A. Overbeek ◽

Djuna Cahen ◽

Anne Kamps ◽

Ingrid C. Konings ◽

Femme Harinck ◽

...

Keyword(s):

Pancreatic Cancer ◽

High Risk ◽

Cancer Surveillance ◽

Patient Reported

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A cost analysis of a pancreatic cancer screening protocol in high-risk populations

The American Journal of Surgery ◽

10.1016/j.amjsurg.2014.11.017 ◽

2015 ◽

Vol 210 (3) ◽

pp. 409-416 ◽

Cited By ~ 22

Author(s):

Elizabeth Bruenderman ◽

Robert C.G. Martin

Keyword(s):

Pancreatic Cancer ◽

Cancer Screening ◽

High Risk ◽

Cost Analysis ◽

Pancreatic Cancer Screening ◽

Screening Protocol ◽

High Risk Populations

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Prospective observational study of prevalence, assessment and treatment of pancreatic exocrine insufficiency (PEI) in patients with advanced pancreatic cancer (aPC): PanDA.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.196 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 196-196

Author(s):

Angela Lamarca ◽

Lindsay Carnie ◽

Dinakshi Shah ◽

Kate Vaughan ◽

Zainul Abedin Kapacee ◽

...

Keyword(s):

Pancreatic Cancer ◽

High Risk ◽

Observational Study ◽

Breath Test ◽

Cox Regression ◽

Pancreatic Enzyme ◽

Palliative Therapy ◽

Advanced Pancreatic Cancer ◽

P Value ◽

Screening Methods

196 Background: PEI in patients with advanced pancreatic cancer is well documented, but there is a lack of consensus regarding optimal screening. Methods: Eligible patients for this observational study (NCT03616431) were those diagnosed with aPC referred for consideration of palliative therapy who consented to evaluation by a research dietitian. In addition to symptom and full dietetic assessment (including Mid-Upper Arm Circumference (MUAC), handgrip and stair climb test), full nutritional blood panel, faecal elastase (FE) and 13C mixed triglyceride breath test (for diagnostic cohort (DiC)) were performed. Primary objectives: prospective assessment of PEI prevalence (dietitian-assessed; demographic cohort (DeC)), and to design (using breath test as gold standard; DiC) and validate (follow-up cohort (FuC)) the most suitable screening tool for PEI in patients with aPC. Logistic and Cox regression were used for statistical analysis (Stat v.12). Results: Between 1st July 2018 and 30th October 2020, 112 eligible patients [50 (DeC), 25 (DiC), 37 (FuC)]. Prevalence of PEI in the DeC was 64.0% (PEI-related symptoms were flatus (84.0%), weight loss (84.0%), abdominal discomfort (50.0%) and steatorrhea (48.0%)); 70.0% of patients required pancreatic enzyme replacement therapy and 74.0% had anorexia (low appetite); 44.0% and 18.0% had low vitamin D and vitamin A levels, respectively. Designed PEI screening panel (DiC; 19 patients with breath test completed) included FE [normal/missing (0 points); low (1 point)] and MUAC [normal/missing ( > percentile 25 for age/gender) (0 points); low (2 points)] and identified patients at high-risk (2-3 total points) of PEI [vs. low-medium risk (0-1 total points)]. When patients from DeC and DiC) were analysed together, those classified as “high-risk of PEI” according to the screening panel had shorter overall survival (multivariable Hazard Ratio (mHR) 1.86 (95% CI 1.03-3.36); p-value 0.040) when adjusted for other prognostic factors, including presence of PEI symptoms (mHR 2.28 (95% CI 1.19-4.35); p-value 0.013). The screening panel was tested in the FuC; 78.38% were classified as patients at “high-risk of PEI”; of these, 89.6% were confirmed to have PEI by the dietitian. The panel was feasible for use in clinical practice, (64.8% of patients completed fully the assessments required) and acceptability was high (87.5% of patients would do it again). The majority of patients (91.3%) recommended that all future patients with aPC should have dietitian input. Conclusions: PEI is present in the majority of patients with aPC, and early dietetic input is important to provide a holistic nutritional overview, including, but not limited to, PEI. This proposed screening panel could be used to prioritise patients at higher risk of PEI requiring urgent dietitian input. Its prognostic role needs further validation. Clinical trial information: NCT03616431.

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