International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer.
International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer.
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DOI：
10.1136/gutjnl-2012-303108
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发表时间：
2013-03
期刊：
影响因子：
24.5
通讯作者：
International Cancer of Pancreas Screening (CAPS) Consortium
中科院分区：
文献类型：
--
作者：
Canto MI;Harinck F;Hruban RH;Offerhaus GJ;Poley JW;Kamel I;Nio Y;Schulick RS;Bassi C;Kluijt I;Levy MJ;Chak A;Fockens P;Goggins M;Bruno M;International Cancer of Pancreas Screening (CAPS) Consortium
对胰腺癌 (PC) 风险较高的个体进行筛查可以发现早期、可能治愈的胰腺肿瘤。制定关于筛查、监测和管理具有遗传性 PC 倾向的高风险个体的联盟声明。由 49 名多学科专家组成的国际联盟开会讨论胰腺筛查并对声明进行投票。如果同意或不同意≥75%，则视为达成共识。一致认为，要取得成功，筛查计划应检测并治疗 T1N0M0 边缘阴性 PC 和高度发育不良前驱病变（胰腺上皮内瘤变和导管内乳头状粘液性肿瘤）。一致同意以下人群为筛查候选者： PC 患者的一级亲属 (FDR)，其家族性 PC 亲属至少有两名受影响的 FDR；黑斑息肉综合征患者；受影响 FDR ≥1 的 p16、BRCA2 和遗传性非息肉病性结直肠癌 (HNPCC) 突变携带者。对于开始筛查或停止监测的年龄尚未达成共识。一致认为，初步筛查应包括内镜超声检查 (EUS) 和/或 MRI/磁共振胰胆管造影，而不是 CT 或内镜逆行胰胆管造影。对于是否需要进行 EUS 细针抽吸来评估囊肿尚未达成共识。对于最佳筛查方式和随访成像间隔存在分歧。当建议进行手术时，应在高容量中心进行。对于哪些筛查异常值得充分关注并建议进行手术，存在很大分歧。建议对高危人群进行筛查，但需要更多证据，特别是如何管理检测到病变的患者。筛查和后续管理应在具有多学科团队的大容量中心进行，最好在研究方案内进行。
Screening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia. To develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to PC. A 49-expert multidisciplinary international consortium met to discuss pancreatic screening and vote on statements. Consensus was considered reached if ≥75% agreed or disagreed. There was excellent agreement that, to be successful, a screening programme should detect and treat T1N0M0 margin-negative PC and high-grade dysplastic precursor lesions (pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm). It was agreed that the following were candidates for screening: first-degree relatives (FDRs) of patients with PC from a familial PC kindred with at least two affected FDRs; patients with Peutz–Jeghers syndrome; and p16, BRCA2 and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with ≥1 affected FDR. Consensus was not reached for the age to initiate screening or stop surveillance. It was agreed that initial screening should include endoscopic ultrasonography (EUS) and/or MRI/magnetic resonance cholangiopancreatography not CT or endoscopic retrograde cholangiopancreatography. There was no consensus on the need for EUS fine-needle aspiration to evaluate cysts. There was disagreement on optimal screening modalities and intervals for follow-up imaging. When surgery is recommended it should be performed at a high-volume centre. There was great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended. Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions. Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols.
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5.2
作者：
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