Pancreas
J Clin Oncol. 2022;40(28):3257–66
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.