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Challenges in early detection of pancreatic cancer
Abstracts / Pancreatology 16 (2016) S1eS192
Conclusion: Neoadjuvant treatment followed by surgery might provide clinical benefits for BRPC-A patients, however, the establishment of the most appropriate neoadjuvant therapy is needed by further studies.
S2-5. A clinical role of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma Sohei Satoi, Hiroaki Yanagimoto, Tomohisa Yamamoto, Satoshi Hirooka, So Yamaki, Masaya Kotsuka, Hironori Ryota, Yoichi Matsui, Masanori Kon Department of Surgery, Kansai Medical University, Japan Background: Pancreatic surgeons have identified candidates for surgical resection in patients with initially unresectable (UR) pancreatic ductal adenocarcinoma (PDAC) who favorably responded to multimodal treatment. The role of conversion surgery has not been fully determined. Methods: The 310 consecutive patients with UR-PDAC (2006-2014) were retrospectively analyzed in a single institution. Study1; Out of 78 patients who had PR/SD beyond 8 months, 22 patients had additional surgical resection (conversion surgery group), and the remaining 56 patients did not undergo conversion surgery (control group). Clinical backgrounds and overall survival were compared. Univariate and multivariate analyses were performed for indicating prognostic factors. Study 2; The 49 patients were diagnosed as peritoneal metastasis (positive peritoneal washing cytology or peritoneal dissemination) using staging laparoscopy. The 20 patients received weekly i.v. and i.p. paclitaxel (PTX) combined with S-1 (S-1+PTX group), and 29 patients received standard chemotherapy. Clinical backgrounds and overall survival were compared between two groups. Results: Study 1; MST of conversion surgery group (27 months) was significantly better than 19 months of controls (p¼0.0005). The modifiedGPS was the only independent predictive factor for conversion surgery. Multivariate analysis revealed modified-GPS and conversion surgery as prognostic factors. Study 2; The MST was 20 months in S-1+PTX group, which were significantly better than 10 months in control group (p¼0.004). Clinical responses in S-1+PTX group revealed overall response rate in 9/20 patients (45%), and conversion surgery rate in 6/20 patients (30%). The MST in conversion surgery group was 27.8 months, which was significantly better than 11.6 months in non-surgery group (p <0.001). Conclusions: Patients who underwent conversion surgery had significant improvement of survival, relative to patients with long PR/SD who did not undergo conversion surgery. The feasible and effective regimen of chemo (radio) therapy should be explored for proceeding with conversion surgery.
S19
localized pancreatic duct stenosis in cases having indirect findings such as pancreatic duct dilatation or pancreatic cysts. After confirming localized stenosis in the pancreas, brushing cytology during ERCP and repeated pancreatic juice cytology via an endoscopic nasopancreatic drainage tube are helpful to corroborate the diagnosis of Pca in situ. In addition, the Study Group on the Early Detection of Pancreatic Cancer in Japan identified several clinical features of Pca in situ. There are several risk factors of Pca including a family history of pancreatic cancer, obesity, diabetes, chronic pancreatitis, hereditary pancreatitis, smoking, intraductal papillary mucinous neoplasm, pancreatic cysts, and heavy drinking. EBM-based Clinical Guidelines for Pca issued by the Japan Pancreas Society recommended further evaluation to detect Pca if more than one risk factor of Pca exists. Further studies warrant the establishment of a diagnostic algorithm that effectively leads to the early detection of Pca.
S3-1. The trend of early diagnosis for pancreatic cancer in Korean and Asian areas Dong Ki Lee Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, South Korea One of the major challenges to detecting pancreatic cancer (PC) is its late clinical presentation. In the Asian countries, PC is ranked as the high leading cause of cancer death. Because PC in Asians may be clinically similar to the disease in Western, the goals of future research on the disease may also be same in the two populations. For early detection of the PC, defining the high-risk groups is crucial. The clinical guidelines for PC and surveillance of a high-risk group were proposed. However, in real practice, focusing the risk group and surveillance modality is very incomplete and limited. Many imaging modalities often failed to detect PC less than 10 mm (TS1a). Recently, many institutes in Japan and Korea have adapted EUS as their standard procedure because of its higher detection rate of small PC. To improve the detection ability of small PC, molecular imaging with MRI by Chinese group and contrast-enhanced harmonic EUS by Japanese group are studied and applied in practice. Most of the current available serum tumor markers for PC are not sufficient as a screening tool. Recently, panels of bio markers based on genetic and biochemical changes in PC are studied. miRNAs and diabetogenic factors secreted from Pancreatic cancer cells are hot research topic in this field. Besides the bio markers from serum, bio markers from saliva and tear are spotlighted. Onomichi project in Japan may be a good model for detection of early PC in many Asian countries. This project is based on regional network and collaboration between general practitioner and specialists in PC from the referral hospital. As Western countries, all the Asian country clinician and researchers are eager to improve the rate of early detection of PC for saving the patients from this dismal disease.
S3-KL. Challenges in early detection of pancreatic cancer Atsushi Kanno, Atsushi Masamune, Tooru Shimosegawa Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan The mortality rate of pancreatic cancer (Pca) continues to increase. According to the nationwide Pca registry hosted by the Japan Pancreas Society, approximately 65% of patients with a tumor size (TS) of <1 cm in diameter were in stage IA, which had a 5-year survival rate of 69%. The Kaplan-Meier analysis showed that the 5-year survival rates of TS1a (tumor diameter, 3-10 mm) and TS1b (tumor diameter, 10-20 mm) cases were 80.4% and 50.5%, respectively. Furthermore, the 5-year survival rate of stage 0 Pca (Pca in situ) was 85.8%. These results indicated that early detection of Pca is essential to improve the long-term prognosis of Pca patients. Several imaging studies found several indirect imaging characteristics of Pca in situ based on pancreatic duct stenosis. MRCP and EUS are useful to detect
S3-2. Value of EUS screening in patients with high risk factors for pancreatic cancer (focus on familial pancreatic cancer) Marcia Irene Canto Medicine and Oncology, Johns Hopkins Medical Institutions, USA Introduction: In the last decade, screening and surveillance for pancreatic ductal adenocarcinoma (PDAC) and its precursors in high-risk individuals (HRI) has been performed in expert centers within research protocols. HRI include first degree relatives of PDAC patients (with at least a pair of affected) or carriers of PDAC-associated gene mutations, the latter including breast-related cancer (BRCA 1 and 2), Peutz-Jeghers syndrome (STK-11), and p16 (familial atypical multiple mole melanoma syndrome or FAMMM). There is limited value on the clinical value of EUS screening in HRI.
Conclusion: Neoadjuvant treatment followed by surgery might provide clinical benefits for BRPC-A patients, however, the establishment of the most appropriate neoadjuvant therapy is needed by further studies.
S2-5. A clinical role of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma Sohei Satoi, Hiroaki Yanagimoto, Tomohisa Yamamoto, Satoshi Hirooka, So Yamaki, Masaya Kotsuka, Hironori Ryota, Yoichi Matsui, Masanori Kon Department of Surgery, Kansai Medical University, Japan Background: Pancreatic surgeons have identified candidates for surgical resection in patients with initially unresectable (UR) pancreatic ductal adenocarcinoma (PDAC) who favorably responded to multimodal treatment. The role of conversion surgery has not been fully determined. Methods: The 310 consecutive patients with UR-PDAC (2006-2014) were retrospectively analyzed in a single institution. Study1; Out of 78 patients who had PR/SD beyond 8 months, 22 patients had additional surgical resection (conversion surgery group), and the remaining 56 patients did not undergo conversion surgery (control group). Clinical backgrounds and overall survival were compared. Univariate and multivariate analyses were performed for indicating prognostic factors. Study 2; The 49 patients were diagnosed as peritoneal metastasis (positive peritoneal washing cytology or peritoneal dissemination) using staging laparoscopy. The 20 patients received weekly i.v. and i.p. paclitaxel (PTX) combined with S-1 (S-1+PTX group), and 29 patients received standard chemotherapy. Clinical backgrounds and overall survival were compared between two groups. Results: Study 1; MST of conversion surgery group (27 months) was significantly better than 19 months of controls (p¼0.0005). The modifiedGPS was the only independent predictive factor for conversion surgery. Multivariate analysis revealed modified-GPS and conversion surgery as prognostic factors. Study 2; The MST was 20 months in S-1+PTX group, which were significantly better than 10 months in control group (p¼0.004). Clinical responses in S-1+PTX group revealed overall response rate in 9/20 patients (45%), and conversion surgery rate in 6/20 patients (30%). The MST in conversion surgery group was 27.8 months, which was significantly better than 11.6 months in non-surgery group (p <0.001). Conclusions: Patients who underwent conversion surgery had significant improvement of survival, relative to patients with long PR/SD who did not undergo conversion surgery. The feasible and effective regimen of chemo (radio) therapy should be explored for proceeding with conversion surgery.
S19
localized pancreatic duct stenosis in cases having indirect findings such as pancreatic duct dilatation or pancreatic cysts. After confirming localized stenosis in the pancreas, brushing cytology during ERCP and repeated pancreatic juice cytology via an endoscopic nasopancreatic drainage tube are helpful to corroborate the diagnosis of Pca in situ. In addition, the Study Group on the Early Detection of Pancreatic Cancer in Japan identified several clinical features of Pca in situ. There are several risk factors of Pca including a family history of pancreatic cancer, obesity, diabetes, chronic pancreatitis, hereditary pancreatitis, smoking, intraductal papillary mucinous neoplasm, pancreatic cysts, and heavy drinking. EBM-based Clinical Guidelines for Pca issued by the Japan Pancreas Society recommended further evaluation to detect Pca if more than one risk factor of Pca exists. Further studies warrant the establishment of a diagnostic algorithm that effectively leads to the early detection of Pca.
S3-1. The trend of early diagnosis for pancreatic cancer in Korean and Asian areas Dong Ki Lee Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, South Korea One of the major challenges to detecting pancreatic cancer (PC) is its late clinical presentation. In the Asian countries, PC is ranked as the high leading cause of cancer death. Because PC in Asians may be clinically similar to the disease in Western, the goals of future research on the disease may also be same in the two populations. For early detection of the PC, defining the high-risk groups is crucial. The clinical guidelines for PC and surveillance of a high-risk group were proposed. However, in real practice, focusing the risk group and surveillance modality is very incomplete and limited. Many imaging modalities often failed to detect PC less than 10 mm (TS1a). Recently, many institutes in Japan and Korea have adapted EUS as their standard procedure because of its higher detection rate of small PC. To improve the detection ability of small PC, molecular imaging with MRI by Chinese group and contrast-enhanced harmonic EUS by Japanese group are studied and applied in practice. Most of the current available serum tumor markers for PC are not sufficient as a screening tool. Recently, panels of bio markers based on genetic and biochemical changes in PC are studied. miRNAs and diabetogenic factors secreted from Pancreatic cancer cells are hot research topic in this field. Besides the bio markers from serum, bio markers from saliva and tear are spotlighted. Onomichi project in Japan may be a good model for detection of early PC in many Asian countries. This project is based on regional network and collaboration between general practitioner and specialists in PC from the referral hospital. As Western countries, all the Asian country clinician and researchers are eager to improve the rate of early detection of PC for saving the patients from this dismal disease.
S3-KL. Challenges in early detection of pancreatic cancer Atsushi Kanno, Atsushi Masamune, Tooru Shimosegawa Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan The mortality rate of pancreatic cancer (Pca) continues to increase. According to the nationwide Pca registry hosted by the Japan Pancreas Society, approximately 65% of patients with a tumor size (TS) of <1 cm in diameter were in stage IA, which had a 5-year survival rate of 69%. The Kaplan-Meier analysis showed that the 5-year survival rates of TS1a (tumor diameter, 3-10 mm) and TS1b (tumor diameter, 10-20 mm) cases were 80.4% and 50.5%, respectively. Furthermore, the 5-year survival rate of stage 0 Pca (Pca in situ) was 85.8%. These results indicated that early detection of Pca is essential to improve the long-term prognosis of Pca patients. Several imaging studies found several indirect imaging characteristics of Pca in situ based on pancreatic duct stenosis. MRCP and EUS are useful to detect
S3-2. Value of EUS screening in patients with high risk factors for pancreatic cancer (focus on familial pancreatic cancer) Marcia Irene Canto Medicine and Oncology, Johns Hopkins Medical Institutions, USA Introduction: In the last decade, screening and surveillance for pancreatic ductal adenocarcinoma (PDAC) and its precursors in high-risk individuals (HRI) has been performed in expert centers within research protocols. HRI include first degree relatives of PDAC patients (with at least a pair of affected) or carriers of PDAC-associated gene mutations, the latter including breast-related cancer (BRCA 1 and 2), Peutz-Jeghers syndrome (STK-11), and p16 (familial atypical multiple mole melanoma syndrome or FAMMM). There is limited value on the clinical value of EUS screening in HRI.