Progress in the Earlier Detection of Pancreatic Cancer
Menée à partir de données portant sur 411 personnes asymptomatiques dont 178 porteuses d'une mutation du gène CDKN2A, 19 porteuses d'une mutation du gène BRCA1/2 ou PALB2 et 214 atteintes d'un cancer héréditaire du pancréas, cette étude européenne évalue, du point de vue du taux de détection d'un adénocarcinome canalaire du pancréas à un stade résécable, du taux de résection et du taux de survie à 5 ans, l'intérêt d'un programme annuel de surveillance médicale comportant une IRM, une cholangio-pancréatographie par résonance magnétique et/ou une échographie endoscopique
The difficulty of performing pancreatic cancer surveillance in patients genetically susceptible to familial pancreatic cancer (FPC) cannot be emphasized enough. The stakes are quite high because precursor lesions are difficult to detect with current imaging, it is challenging to distinguish incipient neoplasia from lower grade or nonneoplastic cystic lesions, and the outcomes can be lethal if an incipient neoplasia is missed. In the article that accompanies this editorial, the authors, who represent three centers in two countries, have done an outstanding job of using clinical acumen and the tools at hand to improve cancer outcomes in these high-risk patients. The surveillance tools used in this study included magnetic resonance imaging, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. The centers varied in the use of imaging tests, with one center routinely performing both tests on an annual basis. The outcomes of the FPC cohorts are summarized on the basis of the genetic basis for susceptibility for pancreatic ductal adenocarcinoma (PDAC; eg, CDKN2a/p16-Leiden mutations carriers are one cohort, BRCA/PALB2 mutation carriers are a second cohort, and the third cohort was composed of heterogeneous patients with FPC, in whom the genetic basis for the disease remains unknown). The goal of the surveillance was to identify early-stage PDAC or neoplastic precursor lesions in asymptomatic individuals and determine whether this, in turn, would change the prognosis of PDAC.
Journal of Clinical Oncology , éditorial en libre accès, 2016