Screening of high-risk groups can increase the survival of diagnosed patients by 6.5 times

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Screening of high-risk groups can increase the survival of diagnosed patients by 6.5 times

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JCO: Screening of high-risk groups can increase the survival of diagnosed patients by 6.5 times.

Pancreatic cancer is globally recognized as the “king of cancers”. Studies have predicted that by 2026, pancreatic cancer will become the second most deadly cancer in the United States, and this is likely to occur in many countries due to the rising incidence of pancreatic cancer worldwide [1-2].

The incidence of pancreatic cancer is actually not high, and the number of deaths is still because it is too brutal

However, the new annual cancer data released by the American Cancer Society in 2022 shows that the 5-year survival rate of pancreatic cancer patients in the United States is now 11%, an increase from the previous 8% [3]. Pancreatic cancer treatment has not yet achieved a breakthrough, so what is the reason for the improved survival rate?

The answer is actually very old-fashioned: early detection, early diagnosis, and early treatment, but early pancreatic cancer lacks typical symptoms, so effective screening is needed to catch the cancer.

From the data from 2004 to 2016 in the United States, the number of pancreatic cancer patients diagnosed in stage IA is increasing at an average annual rate of 14.5%, which is due to screening [4].

A recent study led by a team at the Johns Hopkins Pancreatic Cancer Center has reconfirmed the value of pancreatic cancer screening for high-risk groups: most pancreatic cancers diagnosed through screening are diagnosed in stage I.

And the 5-year survival rate of patients reached 73.3%, and the median overall survival (OS) was close to 10 years (9.8 years) !

The median OS of pancreatic cancer patients diagnosed outside of screening is only 1.5 years.

In this comparison, the survival benefit achieved by pancreatic cancer screening is really significant. It seems that fighting against the “cancer king” still has to Screening first [5]. The study was published in the Journal of Clinical Oncology .

At present, the high-risk groups of pancreatic cancer defined by the academic community are mainly those with a family history of pancreatic cancer , that is, parents, children, siblings, and other first-degree relatives who have been diagnosed ; and people with specific gene mutations , such as the well-known BRCA1/2 mutation, which is related to increased risk of pancreatic cancer.

But even for these high-risk groups, screening has been controversial.

The relevant opinion of the United States Preventive Services Task Force (USPSTF) in 2019 believes that the screening of high-risk groups is still in the “research stage”, and the benefits are not clear [6].

Since there is controversy, let the data speak, and Johns Hopkins University has been deeply involved in this aspect, and has carried out a series of multi-center pancreatic cancer screening (CAPS) studies.

The data reported in this report are mainly CAPS launched in 2014. -5 studies, and patient survival data from the CAPS series since its inception in 1998.

The CAPS-5 study has made innovations in the scope and means of screening, such as the definition of high-risk groups including family history, carrying BRCA1/2 and other gene mutations, and familial atypical multiple mole melanoma syndrome (FAMMM) , Peutz-Jeghers syndrome and other genetic syndromes associated with pancreatic cancer, screening methods are endoscopic ultrasonography (EUS) and magnetic resonance/magnetic resonance cholangiopancreatography (MRI/MRCP) .

Times are developing, and research concepts and methods are also progressing

A total of 1,461 high-risk groups of pancreatic cancer were included in the study.

By the end of 2021, the median follow-up time for nearly 70% of the high-risk groups was 4 years, and the follow-up and screening time for the remaining groups was insufficient.

A total of 9 cases of pancreatic cancer were diagnosed by screening, and 7 of them (77.8%) were still stage I at the time of diagnosis.

This is a remarkable proportion, considering that in 2016, only 5.4% of all pancreatic cancer patients in the United States were diagnosed at stage I. Early diagnosis means that patients can basically receive comprehensive treatment, mainly surgery, to achieve long-term survival and even clinical cure.

In addition, 3 cases of precancerous lesions of pancreatic cancer were found in the screening.

From the data of the entire CAPS study, a total of 26 cases of pancreatic cancer were diagnosed in 1731 high-risk groups, of which 19 cases were diagnosed during screening, and more than half (11 cases) were also in stage I, while those diagnosed outside screening were also diagnosed. Of the 7 patients, 6 were unfortunately diagnosed at stage IV .

The staging at the time of diagnosis is completely different, resulting in a huge difference in the median OS of these two groups of patients of 9.8 years and 1.5 years.

After adjusting for risk factors such as age and gene mutation, the survival benefit effect of screening is even greater. Significant, equivalent to a 96% reduction in the risk of death for confirmed patients (HR=0.04) !

Can catch most cancers at an early stage, this is the value of screening

Although the total number of diagnoses in the CAPS study is not large and the follow-up period is relatively limited, the 5-year survival rate of 73.3% is really eye-catching in the field of pancreatic cancer.

It is hoped that these data will be recognized by authoritative guidelines as soon as possible, and help more pancreatic cancer patients to broaden their livesImage

references:

1. Rahib L, Wehner MR, Matrisian LM, et al. Estimated projection of US cancer incidence and death to 2040[J]. JAMA Network Open, 2021, 4(4): e214708.

2. Huang J, Lok V, Ngai CH, et al. Worldwide burden of, risk factors for, and trends in pancreatic cancer[J]. Gastroenterology, 2021, 160(3): 744-754.

3. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022[J]. CA: A Cancer Journal for Clinicians, 2022, 72(1): 7-33.

4. Blackford AL, Canto MI, Klein AP, et al. Recent trends in the incidence and survival of stage 1A pancreatic cancer: a surveillance, epidemiology, and end results analysis[J]. JNCI: Journal of the National Cancer Institute, 2020 , 112(11): 1162-1169.

5. Dbouk M, Katona BW, Brand RE, et al. The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival[J]. Journal of Clinical Oncology, 2022: JCO. 22.00298.

6. Owens DK, Davidson KW, Krist AH, et al. Screening for pancreatic cancer: US Preventive Services Task Force reaffirmation recommendation statement[J]. JAMA, 2019, 322(5): 438-444.

Screening of high-risk groups can increase the survival of diagnosed patients by 6.5 times

(source:internet, reference only)

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