Short-term Results of a Magnetic Resonance Imaging-Based Swedish Screening Program for Individuals at Risk for Pancreatic Cancer
Short-term Results of a Magnetic Resonance Imaging-Based Swedish Screening Program for Individuals at Risk for Pancreatic Cancer
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DOI：
10.1001/jamasurg.2014.3852
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发表时间：
2015-06-01
期刊：
影响因子：
16.9
通讯作者：
Lohr, J. -Matthias
中科院分区：
文献类型：
--
作者：
Del Chiaro, Marco;Verbeke, Caroline S.;Lohr, J. -Matthias
胰腺癌是西方国家癌症相关死亡的第四大原因。在大约10%的胰腺癌患者中，有可能确定胰腺癌或其他相关遗传综合征的阳性家族史。建议对有风险的个人进行筛查；然而，监测方式尚未确定。目的：分析一项基于无创磁共振成像（MRI）筛查方案的胰腺癌高危人群前瞻性临床监测项目的短期结果。设计、设置和参与者：一项前瞻性观察研究，对2010年1月1日至2013年1月31日期间转诊至卡罗林斯卡大学医院的所有有胰腺癌遗传风险的患者，采用基于mri的监测项目。所有患者都被调查了与胰腺癌相关的最常见的基因突变。一种基于核磁共振成像的无创筛查方案。主要结果和指标MRI识别胰腺癌高危个体潜在癌前或早期癌症的能力。结果共纳入40例患者，其中女性24例，男性16例。平均年龄49.9岁。平均随访时间12.9个月。亲属患胰腺癌的人数分别为2例5例（5%）、5例4例（12.5%）、17例3例（42.5%）、14例2例（35%）、2例1例（5%）。4例患者（10%）发现p16突变；3例为BRCA2突变（7.5%）；1例为BRCA1突变（2.5%）。16例患者（40%）MRI显示胰腺病变：导管内乳头状粘液瘤（14例，35%）和胰腺导管腺癌（2例，5%）。1例患者同时有导管内乳头状粘液瘤和胰腺导管腺癌。5例患者（12.5%）需要手术治疗（3例为胰腺导管腺癌，2例为导管内乳头状粘液瘤），其余35例仍在持续监测中。结论和相关性在中位随访约1年期间，40%的患者发现胰腺病变，其中5例接受了手术。虽然研究时间相对较短，但对高危个体的监测项目似乎是有效的。
IMPORTANCE Pancreatic cancer is the fourth leading cause of cancer-related death in Western countries. In approximately 10% of all patients with pancreatic cancer, it is possible to define a positive family history for pancreatic cancer or for one of the other related genetic syndromes. A screening program for individuals at risk is recommended; however, surveillance modalities have not been defined yet.OBJECTIVE To analyze the short-term results of a prospective clinical surveillance program for individuals at risk for pancreatic cancer using a noninvasive magnetic resonance imaging (MRI)-based screening protocol.DESIGN, SETTING AND PARTICIPANTS A prospective observational study of all patients with a genetic risk for developing pancreatic cancer who were referred to Karolinska University Hospital between January 1, 2010, and January 31, 2013, using an MRI-based surveillance program. All patients were investigated for the most common genetic mutations associated with pancreatic cancer.EXPOSURE A noninvasive MRI-based screening protocol.MAIN OUTCOMES AND MEASURES The ability of MRI to identify potential precancerous or early cancers in individuals at risk for pancreatic cancer.RESULTS Forty patients (24 women and 16 men) were enrolled. The mean age was 49.9 years. The mean length of follow-up was 12.9 months. The numbers of relatives affected by pancreatic cancer were 5 in 2 patients (5%), 4 in 5 patients (12.5%), 3 in 17 patients (42.5%), 2 in 14 patients (35%), and 1 in 2 patients (5%). In 4 patients (10%), a p16 mutation was found; in 3, a BRCA2 mutation (7.5%); and in 1, a BRCA1 mutation (2.5%). In 16 patients (40%), MRI revealed a pancreatic lesion: intraductal papillary mucinous neoplasia (14 patients, 35%) and pancreatic ductal adenocarcinoma (2 patients, 5%). One patient had a synchronous intraductal papillary mucinous neoplasia and pancreatic ductal adenocarcinoma. Five patients (12.5%) required surgery (3 for pancreatic ductal adenocarcinoma and 2 for intraductal papillary mucinous neoplasia), while the remaining 35 are under continued surveillance.CONCLUSIONS AND RELEVANCE During a median follow-up of approximately 1 year, pancreatic lesions were detected in 40% of the patients, of whom 5 underwent surgery. Although the study time was relatively short, the surveillance program in individuals at risk seems to be effective.