Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD.
Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
J Clin Oncol. 2022 Oct 1;40(28):3257-3266. doi: 10.1200/JCO.22.00298. Epub 2022 Jun 15.
To report pancreas surveillance outcomes of high-risk individuals within the multicenter Cancer of Pancreas Screening-5 (CAPS5) study and to update outcomes of patients enrolled in prior CAPS studies.
Individuals recommended for pancreas surveillance were prospectively enrolled into one of eight CAPS5 study centers between 2014 and 2021. The primary end point was the stage distribution of pancreatic ductal adenocarcinoma (PDAC) detected (stage I higher-stage). Overall survival was determined using the Kaplan-Meier method.
Of 1,461 high-risk individuals enrolled into CAPS5, 48.5% had a pathogenic variant in a PDAC-susceptibility gene. Ten patients were diagnosed with PDAC, one of whom was diagnosed with metastatic PDAC 4 years after dropping out of surveillance. Of the remaining nine, seven (77.8%) had a stage I PDAC (by surgical pathology) detected during surveillance; one had stage II, and one had stage III disease. Seven of these nine patients with PDAC were alive after a median follow-up of 2.6 years. Eight additional patients underwent surgical resection for worrisome lesions; three had high-grade and five had low-grade dysplasia in their resected specimens. In the entire CAPS cohort (CAPS1-5 studies, 1,731 patients), 26 PDAC cases have been diagnosed, 19 within surveillance, 57.9% of whom had stage I and 5.2% had stage IV disease. By contrast, six of the seven PDACs (85.7%) detected outside surveillance were stage IV. Five-year survival to date of the patients with a screen-detected PDAC is 73.3%, and median overall survival is 9.8 years, compared with 1.5 years for patients diagnosed with PDAC outside surveillance (hazard ratio [95% CI]; 0.13 [0.03 to 0.50], = .003).
Most pancreatic cancers diagnosed within the CAPS high-risk cohort in the recent years have had stage I disease with long-term survival.
报告多中心癌症胰腺筛查-5（CAPS5）研究中高危人群的胰腺监测结果，并更新之前 CAPS 研究中入组患者的结果。
2014 年至 2021 年期间，建议进行胰腺监测的个体前瞻性入组到 8 个 CAPS5 研究中心之一。主要终点是检测到的胰腺导管腺癌（PDAC）的分期分布（I 期及以上）。使用 Kaplan-Meier 方法确定总生存期。
在入组 CAPS5 的 1461 名高危个体中，48.5%的个体存在 PDAC 易感性基因的致病性变异。10 名患者被诊断为 PDAC，其中 1 名在退出监测 4 年后被诊断为转移性 PDAC。在其余 9 名患者中，有 7 名（77.8%）在监测期间被检测到 I 期 PDAC（通过手术病理学）；1 名患者为 II 期，1 名患者为 III 期。这 9 名 PDAC 患者中有 7 名在中位随访 2.6 年后仍存活。另外 8 名患者因可疑病变行手术切除；3 名患者切除标本中存在高级别异型增生，5 名患者存在低级别异型增生。在整个 CAPS 队列（CAPS1-5 研究，1731 名患者）中，共诊断出 26 例 PDAC 病例，其中 19 例在监测中，57.9%为 I 期，5.2%为 IV 期。相比之下，在监测外发现的 7 例 PDAC 中，有 6 例（85.7%）为 IV 期。目前，筛查发现的 PDAC 患者的 5 年生存率为 73.3%，中位总生存期为 9.8 年，而在监测外诊断为 PDAC 的患者的中位总生存期为 1.5 年（风险比[95%CI]；0.13[0.03 至 0.50]，P=0.003）。
近年来 CAPS 高危人群中诊断的大多数胰腺癌均为 I 期，具有长期生存。
