Staging may be inaccurate in up to 80% of patients with early pancreatic cancer, according to a recent study published by Perrotta et al in JAMA. The findings underscored the need for advancements in diagnostic technology and staging, which may help to improve early pancreatic cancer treatment and research.
Background
Diagnosis and staging of pancreatic cancer are often challenging because the pancreas is located deep within the body and current imaging technology isn’t always able to detect smaller tumors or lymph node involvement. Lymph nodes are an important factor in cancer staging and a key difference between early-stage and later-stage pancreatic cancers.
Although the 5-year survival rate in patients with stage I pancreatic cancer is more than 83%, this rate declines to just 3% among patients with stage IV disease—which is when most patients are currently diagnosed.
Pancreatic cancer screening employs magnetic resonance imaging and endoscopic ultrasound. Screening is recommended in patients with a family history of pancreatic cancer and those who carry variants in certain genes associated with the disease.
“Patients who have lymph node involvement have a worse survival rate than those without lymph node involvement. When imaging is unable to detect lymph node involvement, staging may not reflect the true extent of the disease,” explained senior study author Srinivas Gaddam, MD, MPH, Associate Professor of Medicine, Associate Director of Pancreatic Biliary Research, and Head of the Pancreatic Cancer Screening and Early Detection Program at Cedars-Sinai.
Study Methods and Results
In this study, investigators focused on the National Cancer Database to examine the data of more than 48,000 patients. Based on preoperative imaging, all of the patients involved in the study had either stage I or II pancreatic cancer. Following surgery to remove their tumors, more than 78% of the patients with stage I pancreatic cancer and more than 29% of those with stage II disease were upstaged to a stage that generally included lymph node involvement.
“Our research reveals that staging—essential for making treatment decisions and determining research eligibility—is often inaccurate in early-stage pancreatic cancer,” stressed Dr. Gaddam. “As the field is racing toward earlier diagnosis, early staging will become increasingly important,” he added.
Conclusions
“Our findings suggest that lymph node involvement is being missed in four out of every five patients during the staging process. We know that our current screening and staging tools aren’t great,” indicated Dr. Gaddam. “[Our] hope is that within the next 10 years, we will develop advanced tools for screening and staging pancreatic cancer, allowing us to diagnose most patients at stage I and stage II rather than stage IV. With these advancements, we can catch this disease much earlier, improving outcomes for many more patients,” he highlighted.
The investigators advised physicians who stage pancreatic cancer to recognize the limitations of current imaging technology and actively assess and report lymph node involvement.
“Pancreatic cancer is a difficult diagnosis, and there is a tremendous need to improve outcomes for patients,” emphasized Dan Theodorescu, MD, PhD, Director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair at Cedars-Sinai. “Through leading-edge tools, such as our Molecular Twin Precision Oncology Platform, we are developing tests that will guide precision treatment of pancreatic and other cancers. We first demonstrated the utility of Molecular Twin by identifying new biomarkers for pancreatic cancer; these biomarkers assist in the diagnosis, which must be coupled with accurate cancer staging to appropriately guide therapeutics,” he concluded.
Disclosure: The research in this study was funded in part by the American Gastroenterological Association (AGA) Research Foundation’s 2022 AGA–Bern Schwartz Family Fund Research Scholar Award in Pancreatic Cancer. For full disclosures of the study authors, visit jamanetwork.com.
