Abstract
Simple SummaryThe early detection of pancreatic cancer is required to improve prognosis. We aimed to analyze the predictive factors of neoplastic progression in patients at high risk for pancreatic cancer and examined the efficiency of surveillance using transabdominal special ultrasonography focusing on the pancreas (special pancreatic US). On long-term surveillance with special pancreatic US of 498 patients who had main pancreatic duct (MPD) dilatation (≥2.5 mm) and/or pancreatic cysts (≥5 mm), neoplastic progression developed in 11 patients (2.2%). Findings of both MPD dilatation and pancreatic cysts, MPD growth (≥0.2 mm/year) and cyst growth (≥2 mm/year) during surveillance were risk factors for neoplastic progression. Periodic surveillance using special pancreatic US allowed the early diagnosis of neoplastic progression (stage 0/I: 72.7%), leading to a favorable prognosis (overall survival: 8.8 years). This study clarified the efficiency of surveillance with special pancreatic US for high-risk individuals and key changes during surveillance to watch for.Because pancreatic cancer has a dismal prognosis, a strategy for early diagnosis is required. This study aimed to identify predictive factors of neoplastic progression in patients at high risk for pancreatic cancer and examined the efficiency of surveillance using transabdominal special ultrasonography focusing on the pancreas (special pancreatic US). Patients with slight main pancreatic duct (MPD) dilatation (≥2.5 mm) and/or pancreatic cysts (≥5 mm) were enrolled in a prospective surveillance study with special pancreatic US in a Japanese cancer referral center. A total of 498 patients undergoing surveillance for ≥3 years were included. During the median follow-up of 5.9 years, neoplastic progression developed in 11 patients (2.2%), including 9 patients who underwent pancreatectomy. Eight patients (72.7%) were diagnosed with stage 0/I disease, with an overall survival duration of 8.8 years. Findings of both MPD dilatation and pancreatic cysts at initial surveillance, MPD growth (≥0.2 mm/year) and cyst growth (≥2 mm/year) during surveillance were identified as independent risk factors for neoplastic progression. In summary, surveillance with special pancreatic US for high-risk individuals contributed to earlier detection of neoplastic progression, leading to a favorable prognosis. During surveillance, attention should be paid to MPD growth as well as to cyst growth.
Highlights
The number of pancreatic cancer (PC) patients is increasing, and PC has become the third leading cause of cancer-related death in the United States [1,2]
Because this study evaluated the cumulative incidence of neoplastic progression and identified its predictors during surveillance, we excluded patients who satisfied the following conditions: (1) periodic surveillance for less than 3 years after the initiation of surveillance (n = 88); (2) a diagnosis of serous cystic neoplasm, mucinous cystic neoplasm, pancreatic neuroendocrine neoplasm or chronic pancreatitis on imaging and/or pathology (n = 31); (3) main pancreatic duct (MPD) dilatation ≥10 mm or a mural nodule (≥5 mm) detected at surveillance initiation (n = 7); and (4) the presence of suspected PC during surveillance with patient refusal to undergo further examination (n = 1)
We demonstrated that findings of both MPD dilatation and the presence of pancreatic cysts at initial surveillance were identified as independent predictive factors of neoplastic progression
Summary
The number of pancreatic cancer (PC) patients is increasing, and PC has become the third leading cause of cancer-related death in the United States [1,2]. PC has a poor prognosis, with a 5-year overall survival rate of 9% [1]. 80% of PC patients are diagnosed with metastatic or locally advanced disease because PC causes no or nonspecific symptoms in the early stage [3]. The 5-year survival rate of patients with tumors smaller than 10 mm (TS1a) was 80.4%, and that of patients with UICC stage. Based on a prospective follow-up, we previously reported that slight dilatation of the main pancreatic duct (MPD) (≥2.5 mm) and the presence of pancreatic cysts were risk factors for the subsequent development of PC [8]. Periodic follow-up for patients who have slight MPD dilatation and/or pancreatic cysts could be a promising strategy for the early detection of PC
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