32 Outcomes of Pancreatic Cancer Surveillance in High Risk Individuals

Abstract

INTRODUCTION: Consensus guidelines recommend surveillance for pancreatic cancer (PC) for individuals who meet specific high-risk criteria, however outcome data are lacking. We report findings of pancreatic surveillance in individuals at high risk for PC. METHODS: Subjects at high risk for PC were identified through the Cancer Genetics Registry at the University of Michigan. High risk individuals (HRI) included the following: 1) familial pancreatic cancer (FPC) defined as ≥3 relatives, or 2 first degree relatives with PC, 2) pathogenic germline variant in BRCA1/BRCA2, PALB2, ATM or Lynch Syndrome (LS) DNA Mismatch repair genes (LS) with ≥1 relative affected with PC or 3) pathogenic germline variant in CDKN2A, STK11, or PRSS1. Results of pancreatic imaging tests were ascertained through chart review. RESULTS: 121 patients (65 FPC, 20 CDKN2A, 13 LS, 10 ATM, 6 STK11, 4 BRCA, 2 PALB2,1 PRSS1) underwent ≥1 pancreatic imaging tests. Mean age at first screening was 56 ± 10 y with mean of 4 exams per subject (range 1–16). 53 (44%) subjects had abnormalities noted on exam, including parenchymal abnormalities in 28 (53%), cystic lesions in 20 (38%) and ductal abnormalities in 3 (6%). 29 (24%) patients had worrisome findings associated with increased risk for PC (multiple cysts (21), possible solid mass (5), dilated main pancreatic duct (3), cyst >3cm (2)). Of these, there were 13 patients (23%) with a germline mutation (5 CDKN2A, 3 ATM, 2 LS, 2 STK11, 1 PRSS1) versus 16 FPC pts (24%) (P = NS). Seven (24%) patients underwent surgical resection after median 1.9 y (range 0.6–8.6 y) surveillance (indication = mass (2), main duct involvement (3), cyst >3 cm (2)) (Table 1). Pathology revealed PC (1), main duct IPMN with high grade dysplasia (1), neuroendocrine tumors (2, both with IPMN), IPMN with low grade dysplasia (2), and chronic pancreatitis (1). In our cohort, there was one other patient (LS) with PC (a 2cm mass found on initial imaging (MRI); pt now undergoing treatment). The remaining 21 pts are cancer-free with mean 4.3 ± 3.8y follow up. CONCLUSION: One in 4 high risk individuals have worrisome pancreatic lesions. The presence of a mass, main duct dilation, and cyst size appear to be the most important findings. Further studies are necessary to better stratify patients and imaging findings at highest risk for progression to PC.