In a Dutch study reported in the Journal of Clinical Oncology, Klatte et al provided findings from a 20-year follow-up of a pancreatic cancer surveillance program including carriers of germline CDKN2A pathogenic variants.
Study Details
The study included 347 carriers in the Netherlands who participated in surveillance for pancreatic ductal adenocarcinoma in a program initiated in the year 2000 at Leiden University Medical Center. Surveillance included annual magnetic resonance imaging with magnetic resonance cholangiopancreatography and optional endoscopic ultrasound.
Key Findings
Participants were followed for a median of 5.6 years (interquartile range [IQR] = 2.3–9.9 years). Among the 347 carriers, 31 (8.9%) were diagnosed with a total of 36 cases of pancreatic ductal adenocarcinoma; 5 were diagnosed with a second primary pancreatic ductal adenocarcinoma. Median age at diagnosis was 60.4 years (IQR = 51.3–64.1 years). The incidence rate of primary pancreatic ductal adenocarcinoma was 14.2 cases per 1,000 person-years at risk, corresponding to an estimated cumulative incidence of 7.3% by age 60 and 20.7% by age 70.
Among the 36 cases of pancreatic ductal adenocarcinoma, 30 (83.3%) were considered resectable at time of imaging; 12 cases were diagnosed at stage I. Among all patients, median overall survival after diagnosis was 26.8 months, with a 5-year rate of 32.4% (95% confidence interval [CI] = 19.1%–54.8%). Among the 22 patients who underwent resection, 5-year survival was 44.1% (95% CI = 27.2%–71.3%). Survival at 3 years among six patients with stage I disease who underwent resection was 83.3%. Among all patients, the 23 diagnosed between 2011 and 2021 had better 3-year survival vs the 8 diagnosed between 2000 and 2010—39.7% vs 12.5%, respectively.
A total of nine participants (2.6%) underwent surgery for suspected malignant lesions, with no pancreatic ductal adenocarcinoma identified; five had lesions with low-grade dysplasia.
The investigators concluded, “This long-term surveillance study demonstrates a high incidence of pancreatic ductal adenocarcinoma in carriers of a pathogenic variant in CDKN2A. This provides evidence that surveillance in such a high-risk population leads to detection of early-stage pancreatic ductal adenocarcinoma with improved resectability and survival.”
Derk C.F. Klatte, MD, of the Department of Gastroenterology and Hepatology, Leiden University Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
