TY - JOUR
T1 - Late-Stage Pancreatic Cancer Detected During High-Risk Individual Surveillance
T2 - A Systematic Review and Meta-Analysis
AU - Chhoda, Ankit
AU - Vodusek, Ziga
AU - Wattamwar, Kapil
AU - Mukherjee, Eric
AU - Gunderson, Craig
AU - Grimshaw, Alyssa
AU - Sharma, Anup
AU - Ahuja, Nita
AU - Kastrinos, Fay
AU - Farrell, James J.
N1 - Funding Information:
Order of Authors (with Contributor Roles):, Ankit Chhoda, MD (Conceptualization: Equal; Data curation: Lead; Formal analysis: Supporting; Investigation: Supporting; Methodology: Equal; Writing – original draft: Lead), Ziga Vodusek, MD (Data curation: Supporting; Writing – original draft: Supporting), Kapil Wattamwar, MD (Data curation: Supporting; Writing – review & editing: Supporting), Eric Mukherjee, MD, PhD (Formal analysis: Supporting; Writing – review & editing: Supporting), Craig Gunderson, MD (Formal analysis: Lead), Alyssa Grimshaw, MSLIS (Data curation: Lead; Project administration: Lead; Resources: Lead; Writing – review & editing: Supporting), Anup Sharma, PhD (Writing – review & editing: Supporting), Nita Ahuja, MD, MBA, FACS (Resources: Supporting; Writing – review & editing: Supporting), Fay Kastrinos, MD, MPH (Methodology: Supporting; Supervision: Supporting; Writing – review & editing: Supporting), James J. Farrell, MD (Resources: Lead; Writing – original draft: Supporting; Writing – review & editing: Lead) Funding None
Publisher Copyright:
© 2022 AGA Institute
PY - 2022/3
Y1 - 2022/3
N2 - Background & Aims: Identification and resection of successful targets, that is, T1 N0M0 pancreatic ductal adenocarcinoma (PDAC) and high-grade precursors during surveillance of high-risk individuals (HRIs) confers improved survival. Late-stage PDACs refer to T2–4 N0M0 and nodal or distant metastatic PDAC stages diagnosed during the follow-up phase of HRI surveillance. This study aimed to quantify late-stage PDACs during HRI surveillance and identify associated clinicoradiologic factors. Methods: A systematic search (PROSPERO:CRD42018117189) from Cochrane Library, Embase, Google Scholar, Medline, PubMed, Scopus, and Web of Science was last performed on April 18, 2021. Only original HRI surveillance manuscripts that specified follow-up strategies were included, and studies with only baseline information were excluded. Cumulative incidences of advanced neoplasia: high-grade precursors and all PDACs, and surveillance-detected/interval late-stage PDACs were calculated through random-effects model. Incidence of late-stage PDACs underwent metaregression to identify association with HRI clinicoradiologic features. Publication bias was assessed through the funnel plot and Egger's regression line. Results: Thirteen original surveillance studies included 2169 HRIs followed over 7302.72 patient-years. Cumulative incidence of advanced neoplasia and late-stage PDACs was 3.3 (95% confidence interval [CI]: 0.6–7.4) and 1.7 (95% CI: 0.2–4.0) per 1000 patient-years, respectively. Late-stage PDACs lacked significant association with surveillance imaging, baseline pancreatic morphology, study location, genetic background, gender, or age. Limited information on diagnostic error, symptoms, timing of presentation, lesion site, and surveillance adherence precluded formal meta-analysis. Conclusion: A sizeable proportion of late-stage PDACs were detected during follow-up. Their incidence lacked association with baseline clinicoradiologic features. Further causal investigation of stage-based outcomes is warranted for overall improvement in HRI surveillance.
AB - Background & Aims: Identification and resection of successful targets, that is, T1 N0M0 pancreatic ductal adenocarcinoma (PDAC) and high-grade precursors during surveillance of high-risk individuals (HRIs) confers improved survival. Late-stage PDACs refer to T2–4 N0M0 and nodal or distant metastatic PDAC stages diagnosed during the follow-up phase of HRI surveillance. This study aimed to quantify late-stage PDACs during HRI surveillance and identify associated clinicoradiologic factors. Methods: A systematic search (PROSPERO:CRD42018117189) from Cochrane Library, Embase, Google Scholar, Medline, PubMed, Scopus, and Web of Science was last performed on April 18, 2021. Only original HRI surveillance manuscripts that specified follow-up strategies were included, and studies with only baseline information were excluded. Cumulative incidences of advanced neoplasia: high-grade precursors and all PDACs, and surveillance-detected/interval late-stage PDACs were calculated through random-effects model. Incidence of late-stage PDACs underwent metaregression to identify association with HRI clinicoradiologic features. Publication bias was assessed through the funnel plot and Egger's regression line. Results: Thirteen original surveillance studies included 2169 HRIs followed over 7302.72 patient-years. Cumulative incidence of advanced neoplasia and late-stage PDACs was 3.3 (95% confidence interval [CI]: 0.6–7.4) and 1.7 (95% CI: 0.2–4.0) per 1000 patient-years, respectively. Late-stage PDACs lacked significant association with surveillance imaging, baseline pancreatic morphology, study location, genetic background, gender, or age. Limited information on diagnostic error, symptoms, timing of presentation, lesion site, and surveillance adherence precluded formal meta-analysis. Conclusion: A sizeable proportion of late-stage PDACs were detected during follow-up. Their incidence lacked association with baseline clinicoradiologic features. Further causal investigation of stage-based outcomes is warranted for overall improvement in HRI surveillance.
KW - Pancreatic Cancer
KW - Surveillance
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85124594261&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124594261&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2021.11.021
DO - 10.1053/j.gastro.2021.11.021
M3 - Article
C2 - 34813861
AN - SCOPUS:85124594261
SN - 0016-5085
VL - 162
SP - 786
EP - 798
JO - Gastroenterology
JF - Gastroenterology
IS - 3
ER -