1 University of Michigan, Ann Arbor, MI.
2 American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2019 Jan 10;37(2):153-164. doi: 10.1200/JCO.18.01489. Epub 2018 Nov 20.
An ASCO provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership and other health care providers. This PCO addresses identification and management of patients and family members with possible predisposition to pancreatic adenocarcinoma.
ASCO convened an Expert Panel and conducted a systematic review of the literature published from January 1998 to June 2018. Results of the databases searched were supplemented with hand searching of the bibliographies of systematic reviews and selected seminal articles and contributions from Expert Panel members' curated files.
All patients diagnosed with pancreatic adenocarcinoma should undergo assessment of risk for hereditary syndromes known to be associated with an increased risk for pancreatic adenocarcinoma. Assessment of risk should include a comprehensive review of family history of cancer. Individuals with a family history of pancreatic cancer affecting two first-degree relatives meet criteria for familial pancreatic cancer (FPC). Individuals (cancer affected or unaffected) with a family history of pancreatic cancer meeting criteria for FPC, those with three or more diagnoses of pancreatic cancer in same side of the family, and individuals meeting criteria for other genetic syndromes associated with increased risk for pancreatic cancer have an increased risk for pancreatic cancer and are candidates for genetic testing. Germline genetic testing for cancer susceptibility may be discussed with individuals diagnosed with pancreatic cancer, even if family history is unremarkable. Benefits and limitations of pancreatic cancer screening should be discussed with individuals whose family history meets criteria for FPC and/or genetic susceptibility to pancreatic cancer. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .
ASCO 临时临床意见（PCO）为 ASCO 会员和其他医疗保健提供者提供及时的临床指导。本 PCO 旨在确定和管理可能患有胰腺腺癌的患者及其家属。
ASCO 召集了一个专家小组，对 1998 年 1 月至 2018 年 6 月期间发表的文献进行了系统回顾。补充了数据库搜索结果，包括对系统评价的参考文献以及专家小组成员的精选专题文章和档案的手工搜索。
所有诊断为胰腺腺癌的患者均应评估已知与胰腺腺癌风险增加相关的遗传性综合征的风险。风险评估应包括对癌症家族史的全面审查。有两名一级亲属患胰腺癌的家族史的个体符合家族性胰腺癌（FPC）标准。有家族性胰腺癌（FPC）家族史且符合 FPC 标准的个体（癌症受累或未受累）、家族中存在三种或更多胰腺癌症诊断的个体以及符合其他与增加胰腺癌风险相关的遗传综合征标准的个体，患胰腺癌的风险增加，是基因检测的候选者。即使家族史无明显异常，也可以与诊断为胰腺癌的个体讨论癌症易感性的种系基因检测。应与符合 FPC 和/或对胰腺癌遗传易感性标准的个体讨论胰腺癌筛查的益处和局限性。更多信息可在 www.asco.org/gastrointestinal-cancer-guidelines 获得。
