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An Analysis Using Propensity Scores Reveals that Monitoring High-Risk Individuals for Pancreatic Cancer Results in Better Outcomes

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Background & Aims: Improved outcomes have been reported by recent high-risk pancreatic cancer surveillance programs. This study looked at whether patients with a CDKN2A/p16 pathogenic variant diagnosed under surveillance had better outcomes for pancreatic ductal adenocarcinoma (PDAC) than those with PDAC diagnosed outside of surveillance.

Method: We compared resectability, stage, and survival in a propensity score-matched cohort using data from the Netherlands Cancer Registry between PDAC patients diagnosed under surveillance and non-surveillance patients. Endurance examinations were adapted to likely impacts of lead time.

Results: The Netherlands Cancer Registry identified 43,762 PDAC patients between January 2000 and December 2020. Based on age at diagnosis, sex, year of diagnosis, and tumor location, 151 non-surveillance patients and 31 patients with PDAC under surveillance were matched 1:15. 5.8% of patients outside of surveillance had stage I cancer, whereas 38.7% of surveillance patients had PDAC (odds ratio [OR], 0.09; (0.04–0.19), 95 percent confidence interval (CI). Overall, a surgical resection was performed on 18.7% of non-surveillance patients versus 71% of surveillance patients (OR, 10.62; 95% CI, 4.56–26.63). With a 5-year survival rate of 32.4% and a median overall survival of 26.8 months, patients on surveillance had a better prognosis than non-surveillance patients, who had a 5-year survival rate of 4.3% and a median overall survival of 5.2 months (hazard ratio, 0.31; 95% CI 0.19–0.50). Surveillance patients had significantly longer survival rates than non-surveillance patients for all adjusted lead times.

Conclusion: Compared to patients with PDAC who are not monitored, those with PDAC who are carriers of a CDKN2A/p16 pathogenic variant experience improved survival, earlier detection, and increased respectability.