lunes, 11 de noviembre de 2019

Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Sc... - PubMed - NCBI

2019 Oct 31. pii: gutjnl-2019-319352. doi: 10.1136/gutjnl-2019-319352. [Epub ahead of print]

Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium.

Goggins M1, Overbeek KA2, Brand R3, Syngal S4, Del Chiaro M5, Bartsch DK6, Bassi C7, Carrato A8, Farrell J9, Fishman E10, Fockens P11, Gress TM12, van Hooft JE13, Hruban RH14, Kastrinos F15,16, Klein A17, Lennon AM18, Lucas A19, Park W15, Rustgi A16, Simeone D20, Stoffel E21, Vasen HFA22, Cahen DL2, Canto MI18, Bruno M23; International Cancer of the Pancreas Screening (CAPS) consortium.

Author information

1: Pathology, Medicine Oncology, Johns Hopkins University, Baltimore, Maryland, USA mgoggins@jhmi.edu.
2: Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
3: Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
4: GI Cancer Genetics and Prevention Program, Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA.
5: Department of Surgery, Division of Surgical Oncology, Denver, Colorado, USA.
6: Division of Visceral, Thoracic and Vascular Surgery, University of Marburg, Marburg, Germany.
7: Department of Surgey, University of Verona, Verona, Italy.
8: Medical Oncology, Hospital Ramón y Cajal, Madrid, Spain.
9: Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
10: The Russell H Morgan Department of Radiology and Radiological Science, Baltimore, Maryland, USA.
11: Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands.
12: Gastroenterology, Endocrinology, Metabolism and Infectiology, University of Marburg, Marburg, Germany.
13: Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
14: Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
15: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York City, New York, USA.
16: Division of Digestive and Liver Diseases, Columbia University, New York City, New York, USA.
17: Oncology, Johns Hopkins University, Baltimore, Maryland, USA.
18: Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
19: Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
20: New York University Medical Center, New York City, New York, USA.
21: University of Michigan, Ann Arbor, Michigan, USA.
22: Gastroenterology and Hepatology, Leiden University, Leiden, The Netherlands.
23: Gastoenterology and Hepatology, Erasmus University Rotterdam, Rotterdam, The Netherlands.

Abstract

BACKGROUND AND AIM:

The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).

METHODS:

A modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed.

RESULTS:

Consensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions.

CONCLUSIONS:

Pancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.