General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Pancreatology. 2018 Jun;18(4):420-428. doi: 10.1016/j.pan.2018.04.002. Epub 2018 Apr 10.
BACKGROUND/OBJECTIVES: Screening/surveillance programs for pancreatic cancer (PC) in familial high-risk individuals (FPC-HRI) have been widely reported, but their merits remain unclear. The data reported so far are heterogeneous-especially in terms of screening yield. We performed a systematic review and meta-analysis of currently available data coming from screening/surveillance programs to evaluate the proportion of screening goal achievement (SGA), overall surgery and unnecessary surgery.
We searched MEDLINE, Embase, PubMed and the Cochrane Library database from January 2000 to December 2016to identify studies reporting results of screening/surveillance programs including cohorts of FPC-HRI. The main outcome measures were weighted proportion of SGA, overall surgery, and unnecessary surgery among the FPC-HRI cohort, using a random effects model. SGA was defined as any diagnosis of resectable PC, PanIN3, or high-grade dysplasia intraductal papillary mucinous neoplasm (HGD-IPMN). Unnecessary surgery was defined as any other final pathology.
In a meta-analysis of 16 studies reporting on 1551 FPC-HRI cases, 30 subjects (1.82%), received a diagnosis of PC, PanIN3 or HGD-IPMNs. The pooled proportion of SGA was 1.4%(95% CI 0.8-2, p < 0.001, I = 0%). The pooled proportion of overall surgery was 6%(95% CI 4.1-7.9, p < 0.001, I = 60.91%). The pooled proportion of unnecessary surgery was 68.1%(95% CI 59.5-76.7, p < 0.001, I = 4.05%); 105 subjects (6.3%) received surgery, and the overall number of diagnoses from non-malignant specimens was 156 (1.5 lesion/subject).
The weighted proportion of SGA of screening/surveillance programs published thus far is excellent. However, the probability of receiving surgery during the screening/surveillance program is non-negligible, and unnecessary surgery is a potential negative outcome.
背景/目的：在家族性高危个体（FPC-HRI）中进行胰腺癌（PC）的筛查/监测计划已被广泛报道，但它们的优点尚不清楚。迄今为止报告的数据存在异质性-特别是在筛查效果方面。我们对来自筛查/监测计划的现有数据进行了系统回顾和荟萃分析，以评估筛查目标实现（SGA）、总体手术和不必要手术的比例。
我们检索了 MEDLINE、Embase、PubMed 和 Cochrane 图书馆数据库，以确定 2000 年 1 月至 2016 年 12 月期间报告 FPC-HRI 队列筛查/监测计划结果的研究。主要观察指标是使用随机效应模型计算 FPC-HRI 队列中的 SGA、总体手术和不必要手术的加权比例。SGA 定义为任何可切除 PC、PanIN3 或高级别上皮内瘤变（HGD-IPMN）的诊断。不必要的手术定义为任何其他最终病理。
对 16 项研究的荟萃分析报告了 1551 例 FPC-HRI 病例，30 例（1.82%）患者诊断为 PC、PanIN3 或 HGD-IPMN。SGA 的总合并比例为 1.4%（95%CI 0.8-2，p<0.001，I=0%）。总体手术的总合并比例为 6%（95%CI 4.1-7.9，p<0.001，I=60.91%）。不必要手术的总合并比例为 68.1%（95%CI 59.5-76.7，p<0.001，I=4.05%）；105 例（6.3%）患者接受了手术，非恶性标本的总诊断数为 156 例（1.5 例/例）。
迄今为止发表的筛查/监测计划的 SGA 加权比例非常出色。然而，在筛查/监测计划中接受手术的概率不可忽视，不必要的手术是一个潜在的负面结果。
