Leiden University Medical Center, Leiden, Netherlands;
Derk C.F. Klatte , Bas Boekestijn , Anke M. Onnekink , Friedo W. Dekker , Lydia G. van der Geest , Martin N.J.M.M. Wasser , Shirin Feshtali , J. Sven D. Mieog , Hans Morreau , Thomas P. Potjer , Akin Inderson , Jurjen J. Boonstra , Hans F.A. Vasen , Saskia Luelmo , Jeanin E. van Hooft , Bert A. Bonsing , Monique E. van Leerdam
Background: 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 (PV) diagnosed during surveillance are better as compared to PDAC patients diagnosed outside surveillance. Methods: In a propensity score matched cohort using data from the Netherlands Cancer Registry, we compared resectability, stage and survival between patients diagnosed in surveillance with non-surveillance PDAC patients. Survival analysis were repeated after adjustment for lead-time bias. Results: Between January 2000 and December 2020, 43 762 patients with PDAC were identified from the NCR. Thirty-one patients with PDAC in surveillance were matched in a 1:5 ratio with 155 non-surveillance patients based on age at diagnosis, sex, and year of diagnosis. In total, 71% of patients in surveillance, as compared to 16% of non-surveillance patients underwent a surgical resection (OR 14.03; 95% CI, 5.92 – 35.85). In surveillance, 39% of patients was diagnosed with stage I cancer, as compared to 6% of non-surveillance PDAC patients (OR 0.10; 95% CI, 0.04 – 0.21). Patients in surveillance had a better prognosis, reflected by a 3-year survival of 32.4% and a median overall survival (OS) of 26.8 months vs. 1.4% 3-year survival and 5.3 months median OS in non-surveillance patients (HR 0.22; 95% 0.14 – 0.36). After adjustment for lead time, PDAC diagnosis in surveillance remained strongly associated with improved survival. Conclusions: Surveillance for PDAC in carriers of a CDKN2A/p16 PV results in earlier detection, increased resectability and improved survival as compared to non-surveillance PDAC patients.
Non-surveillance (n=155) | Surveillance (n=31) | Effect Size (95% CI) | |
---|---|---|---|
Stage I, n (%) | 10 (6.5) | 12 (38.7) | OR 0.10 (0.04 - 0.21) |
Stage II, n(%) | 22 (14.2) | 11 (35.5) | |
Stage III, n(%) | 29 (18.7) | 5 (16.1) | |
Stage IV, n (%)* | 90 (58.1) | 3 (9.7) | |
Surgical resection, n (%) | 23 (14.8) | 22 (71.0) | OR 14.03 (5.92 - 35.85) |
Median OS (95% CI), months | 5.3 (3.9 - 6.6) | 26.8 (20.6 - NA) | HR 0.22 (0.14 - 0.36) |
1-year survival, % (95% CI) | 18.7 (13.5 - 26.0) | 83.9 (71.8 - 97.9) | |
3-year survival, % (95% CI) | 1.4 (0.2 - 8.8) | 32.4 (19.1 - 54.9) | |
5-year survival, % (95% CI) | NA | 32.4 (19.1 - 54.9) |
*n=4 with unknown stage in non-surveillance patients. CI=Confidence Interval. HR=Hazard Ratio. OR=Odds Ratio. OS=Overall Survival.
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