Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Research Affiliates Evidence-based Practice Center, Seattle.
Hepatopancreatobiliary Service, Department of Surgery, University of Washington, Seattle.
JAMA. 2019 Aug 6;322(5):445-454. doi: 10.1001/jama.2019.6190.
Pancreatic adenocarcinoma is the third most common cause of cancer death among men and women in the United States.
To systematically review benefits and harms of screening for pancreatic adenocarcinoma to inform the US Preventive Services Task Force.
MEDLINE, PubMed, and the Cochrane Collaboration Registry of Controlled Trials, from January 2002 through April 27, 2018; surveillance through March 22, 2019.
Studies of adults with or without risk factors for pancreatic adenocarcinoma (eg, family history of pancreatic cancer, personal history of new-onset diabetes) undergoing imaging-based screening; studies of treatment for adults with screen-detected or asymptomatic pancreatic adenocarcinoma. Included study designs were randomized clinical trials, nonrandomized controlled intervention studies, diagnostic accuracy studies with a reference standard, cohort studies, and case-control studies (for evaluation of harms only). Studies consisting entirely of populations with known genetic syndromes associated with pancreatic cancer were excluded.
Two investigators independently reviewed abstracts and full-text articles and rated included studies for quality; data were quantitatively analyzed to calculate a pooled diagnostic yield and narratively synthesized.
Mortality, morbidity, or quality of life; diagnostic accuracy of screening tests; any harm of screening or treatment.
Thirteen fair-quality prospective cohort screening studies (N = 1317) conducted predominantly in populations at high familial risk for pancreatic adenocarcinoma were included. No studies reported on the effect of screening on morbidity or mortality or on the effectiveness of treatment for screen-detected pancreatic adenocarcinoma. Although no studies evaluated the diagnostic accuracy of screening tests, all 13 studies reported the diagnostic yield. Yields ranged from 0 to 75 cases per 1000 persons in studies using endoscopic ultrasound, magnetic resonance imaging, and/or computed tomography-based screening. In total, 18 cases of pancreatic adenocarcinoma were detected in 1156 adults at increased familial risk and 0 cases were detected in 161 average-risk adults. In 8 studies (n = 675) assessing procedural harms of screening, no serious harms from initial screening were reported. Two studies (n = 271) found no evidence of psychosocial harms related to screening. Evidence of surgical harms was limited.
Imaging-based screening in groups at high familial risk can detect pancreatic adenocarcinoma with limited evidence of minimal harms. However, the effect of screening on morbidity and mortality in groups at high familial risk has not been studied, and no data are available in average-risk populations. There is limited evidence to assess benefits or harms of surgical intervention for screen-detected pancreatic adenocarcinoma.
在美国，胰腺癌是男性和女性癌症死亡的第三大常见原因。
系统地回顾筛查胰腺癌的益处和危害，为美国预防服务工作组提供信息。
从 2002 年 1 月到 2018 年 4 月 27 日，通过 MEDLINE、PubMed 和 Cochrane 协作试验注册中心进行检索；通过 2019 年 3 月 22 日的监测进行检索。
对有或没有胰腺癌风险因素（例如，家族性胰腺癌史、新发糖尿病史）的成年人进行基于影像学的筛查；对经筛查发现或无症状的胰腺癌患者进行治疗的研究。包括的研究设计有随机临床试验、非随机对照干预研究、以参考标准为基础的诊断准确性研究、队列研究和病例对照研究（仅用于评估危害）。完全由已知与胰腺癌相关的遗传综合征组成的人群的研究被排除在外。
两名调查员独立审查摘要和全文文章，并对纳入的研究进行质量评估；对数据进行定量分析，以计算汇总诊断率，并进行叙述性综合。
死亡率、发病率或生活质量；筛查试验的准确性；筛查或治疗的任何危害。
纳入了 13 项质量尚可的前瞻性队列筛查研究（N=1317），这些研究主要在胰腺癌家族风险较高的人群中进行。没有研究报告筛查对发病率或死亡率的影响，也没有研究报告筛查发现的胰腺癌的治疗效果。虽然没有研究评估筛查试验的诊断准确性，但所有 13 项研究都报告了诊断率。在使用内镜超声、磁共振成像和/或计算机断层扫描进行筛查的研究中，诊断率从每 1000 人 0 例至 75 例不等。在 1156 名高危家族风险的成年人中，共有 18 例胰腺癌被检出，而在 161 名低危风险成年人中则没有检出。在 8 项研究（n=675）评估筛查的程序危害中，没有报告初始筛查的严重危害。有两项研究（n=271）发现没有与筛查相关的心理社会危害的证据。手术危害的证据有限。
在高家族风险人群中进行基于影像学的筛查可以检测到胰腺癌，但其对高家族风险人群发病率和死亡率的影响尚未研究，在低风险人群中也没有数据。有限的证据评估了对筛查发现的胰腺癌进行手术干预的益处或危害。
