As reported in the Journal of Clinical Oncology by Dbouk et al, in the multicenter Cancer of Pancreas Screening-5 (CAPS5) study and in the total CAPS cohort (CAPS1–5 studies), cases of pancreatic ductal adenocarcinoma among enrolled high-risk individuals that were screen-detected during surveillance were diagnosed at earlier stages vs those diagnosed outside of surveillance. Diagnosis within the surveillance period was associated with improved survival outcomes.
The study involved data from 1,461 high-risk individuals enrolled in CAPS5 between 2014 and 2021 and from a total of 1,731 high-risk individuals enrolled in the total CAPS cohort, comprising the CAPS1–5 studies; the CAPS1–4 studies were single-institution studies initiated at Johns Hopkins in 1998. High-risk was defined as lifetime risk ≥ 5% based on the number of affected first-degree relatives with pancreatic cancer or identification of a pathogenic germline variant in a pancreatic cancer susceptibility gene. Participants were recommended to undergo (typically annual) pancreas imaging surveillance with magnetic resonance imaging and endoscopic ultrasound. The primary outcome measure was stage distribution among participants developing pancreatic ductal adenocarcinoma.
Key Findings
Among the 1,461 participants in CAPS5, 10 participants were diagnosed with pancreatic ductal adenocarcinoma, including 9 with disease that was screen-detected within the surveillance period. Of these nine patients, stage at diagnosis was I in seven (78%), II in one, and III in one. The participant diagnosed after dropping out of surveillance was diagnosed with stage IV disease. Seven of the nine patients diagnosed within surveillance remained alive after a median follow-up of 2.6 years. An additional eight participants underwent surgical resection for suspicious lesions, with three having high-grade and five having low-grade dysplasia in resected specimens.
In the entire CAPS cohort of 1,731 participants, 26 were diagnosed with pancreatic ductal adenocarcinoma, including 19 with screen-detected disease within surveillance. Among cases detected within surveillance, stage at diagnosis was I in 11 patients (58%), II in 3, III in 4, and IV in 1. Among the seven cases detected outside surveillance, stage at diagnosis was I in one and IV in six (86%).
In the entire cohort to date, 5-year overall survival among patients with screen-detected disease was 73.3% (95% confidence interval = 54%–100%). Median overall survival was 9.8 years (95% CI = 5.2 years–not estimable) among those with screen-detected disease vs 1.5 years (95% CI = 0.50 years–not estimable) among patients diagnosed with pancreatic ductal adenocarcinoma outside surveillance (hazard ratio = 0.13, 95% CI = 0.03–0.50, P = .003).
The investigators concluded, “Most pancreatic cancers diagnosed within the CAPS high-risk cohort in the recent years have had stage I disease with long-term survival.”
Michael Goggins, MB, MD, of Johns Hopkins Medical Institutions, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Institutes of Health and others. For full disclosures of the study authors, visit ascopubs.org.
