Pancreas
Gastroenterology. 2023;164(7):1223−31.e4
Surveillance for pancreatic cancer in high-risk individuals leads to improved outcomes: A propensity score-matched analysis
Background and aims: Recent pancreatic cancer surveillance programs of high-risk individuals have reported improved outcomes. This study assessed to what extent outcomes of pancreatic ductal adenocarcinoma (PDAC) in patients with a CDKN2A/p16 pathogenic variant diagnosed under surveillance are better as compared with patients with PDAC diagnosed outside surveillance.
Methods: In a propensity score-matched cohort using data from the Netherlands Cancer Registry, the authors compared resectability, stage, and survival between patients diagnosed under surveillance with non-surveillance patients with PDAC. Survival analyses were adjusted for potential effects of lead time.
Results: Between January 2000 and December 2020, 43,762 patients with PDAC were identified from the Netherlands Cancer Registry. 31 pa-tients with PDAC under surveillance were matched in a 1:5 ratio with 155 non-surveillance patients based on age at diagnosis, sex, year of diagno-sis, and tumor location. Outside surveillance, 5.8% of the patients had stage I cancer, as compared with 38.7% of surveillance patients with PDAC (odds ratio [OR] = 0.09; 95% confidence interval [CI]: 0.04−0.19). In total, 18.7% of non-surveillance patients versus 71.0% of surveillance pa-tients underwent a surgical resection (OR = 10.62; 95% CI: 4.56−26.63). Patients in surveillance had a better prognosis, reflected by a 5-year survival of 32.4% and a median overall survival of 26.8 months versus 4.3% 5-year survival and 5.2 months median overall survival in non-surveillance patients (hazard ratio = 0.31; 95% CI: 0.19−0.50). For all adjusted lead times, survival remained significantly longer in surveil-lance patients than in non-surveillance patients.
Conclusion: Surveillance for pancreatic ductal adenocarcinoma (PDAC) in carriers of a CDKN2A/p16 pathogenic variant results in earlier detection, increased resectability, and improved survival as compared with non-surveillance patients with PDAC.