J Clin Oncol. 2022;40(28):3257–66

Dbouk M, Katona BW, Brand RE, Chak A, Syngal S, Farrell JJ, Kastrinos F, Stoffel EM, Blackford AL, Rustgi AK, Dudley B, Lee LS, Chhoda A, Kwon R, Ginsberg GG, Klein AP, Kamel I, Hruban RH, He J, Shin EJ, Lennon AM, Canto MI, Goggins M

The multicenter Cancer of Pancreas Screening study: Impact on stage and survival

Purpose: To report pancreas surveillance outcomes of high-risk individuals within the multicenter Cancer of Pancreas Screening-5 (CAPS5) study and to update outcomes of patients enrolled in prior CAPS studies.
Methods: Individuals recommended for pancreas surveillance were prospectively enrolled into 1 of 8 CAPS5 study centers between 2014 and 2021. The primary end point was the stage distribution of pancreatic ductal adenocarcinoma (PDAC) detected (stage I vs. higher-stage). Overall survival was determined using the Kaplan-Meier method.
Results: Of 1461 high-risk individuals enrolled into CAPS5, 48.5% had a pathogenic variant in a PDAC-susceptibility gene. Ten patients were diagnosed with PDAC, 1 of whom was diagnosed with metastatic PDAC 4 years after dropping out of surveillance. Of the remaining 9, 7 (77.8%) had a stage I PDAC (by surgical pathology) detected during surveillance; 1 had stage II, and 1 had stage III disease. Seven of these 9 patients with PDAC were alive after a median follow-up of 2.6 years. Eight additional patients underwent surgical resection for worrisome lesions; 3 had high-grade and 5 had low-grade dysplasia in their resected specimens. In the entire CAPS cohort (CAPS1–5 studies, 1731 patients), 26 PDAC cases have been diagnosed, 19 within surveillance, 57.9% of whom had stage I and 5.2% had stage IV disease. By contrast, 6 of the 7 PDACs (85.7%) detected outside surveillance were stage IV. Five-year survival to date of the patients with a screen-detected PDAC is 73.3%, and median overall survival is 9.8 years, compared with 1.5 years for patients diagnosed with PDAC outside surveillance (hazard ratio = 0.13; 95% confidence interval: 0.03–0.50; p = 0.003).

Conclusion: Most pancreatic cancers diagnosed within the Cancer of Pancreas Screening high-risk cohort in the recent years have had stage I disease with long-term survival.

M. Goggins, M.D., Professor of Pathology, Medicine and Oncology, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA,

DOI: DOI: 10.1200/jco.22.00298

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