Screening/surveillance programs for pancreatic cancer in familial high-risk individuals: A systematic review and proportion meta-analysis of screening results

Salvatore Paiella; Roberto Salvia; Matteo De Pastena; Tommaso Pollini; Luca Casetti; Luca Landoni; Alessandro Esposito; Giovanni Marchegiani; Giuseppe Malleo; Giulia De Marchi; Aldo Scarpa; Mirko D'Onofrio; Riccardo De Robertis; Teresa Lucia Pan; Laura Maggino; Stefano Andrianello; Erica Secchettin; Deborah Bonamini; Davide Melisi; Massimiliano Tuveri; Claudio Bassi

doi:10.1016/j.pan.2018.04.002

Screening/surveillance programs for pancreatic cancer in familial high-risk individuals: A systematic review and proportion meta-analysis of screening results

Pancreatology. 2018 Jun;18(4):420-428. doi: 10.1016/j.pan.2018.04.002. Epub 2018 Apr 10.

Authors

Salvatore Paiella¹, Roberto Salvia², Matteo De Pastena², Tommaso Pollini², Luca Casetti², Luca Landoni², Alessandro Esposito², Giovanni Marchegiani², Giuseppe Malleo², Giulia De Marchi³, Aldo Scarpa⁴, Mirko D'Onofrio⁵, Riccardo De Robertis⁶, Teresa Lucia Pan², Laura Maggino², Stefano Andrianello², Erica Secchettin², Deborah Bonamini², Davide Melisi⁷, Massimiliano Tuveri², Claudio Bassi²

Affiliations

¹ General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. Electronic address: salvatore.paiella@univr.it.
² General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
³ Gastroenterology B Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
⁴ Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy; ARC-NET Research Center, University and Hospital Trust of Verona, Verona, Italy.
⁵ Department of Radiology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
⁶ Department of Radiology, Casa di Cura Pederzoli Hospital, Peschiera del Garda, Italy.
⁷ Oncology Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.

PMID: 29709409
DOI: 10.1016/j.pan.2018.04.002

Abstract

Background/objectives: Screening/surveillance programs for pancreatic cancer (PC) in familial high-risk individuals (FPC-HRI) have been widely reported, but their merits remain unclear. The data reported so far are heterogeneous-especially in terms of screening yield. We performed a systematic review and meta-analysis of currently available data coming from screening/surveillance programs to evaluate the proportion of screening goal achievement (SGA), overall surgery and unnecessary surgery.

Methods: We searched MEDLINE, Embase, PubMed and the Cochrane Library database from January 2000 to December 2016to identify studies reporting results of screening/surveillance programs including cohorts of FPC-HRI. The main outcome measures were weighted proportion of SGA, overall surgery, and unnecessary surgery among the FPC-HRI cohort, using a random effects model. SGA was defined as any diagnosis of resectable PC, PanIN3, or high-grade dysplasia intraductal papillary mucinous neoplasm (HGD-IPMN). Unnecessary surgery was defined as any other final pathology.

Results: In a meta-analysis of 16 studies reporting on 1551 FPC-HRI cases, 30 subjects (1.82%), received a diagnosis of PC, PanIN3 or HGD-IPMNs. The pooled proportion of SGA was 1.4%(95% CI 0.8-2, p < 0.001, I² = 0%). The pooled proportion of overall surgery was 6%(95% CI 4.1-7.9, p < 0.001, I² = 60.91%). The pooled proportion of unnecessary surgery was 68.1%(95% CI 59.5-76.7, p < 0.001, I² = 4.05%); 105 subjects (6.3%) received surgery, and the overall number of diagnoses from non-malignant specimens was 156 (1.5 lesion/subject).

Conclusions: The weighted proportion of SGA of screening/surveillance programs published thus far is excellent. However, the probability of receiving surgery during the screening/surveillance program is non-negligible, and unnecessary surgery is a potential negative outcome.

Keywords: Diagnostic yield; Familial pancreatic cancer; Pancreatic cancer; Screening program; Surveillance program.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Early Detection of Cancer*
Humans
Pancreatic Neoplasms / diagnosis*
Pancreatic Neoplasms / epidemiology
Pancreatic Neoplasms / genetics*
Pancreatic Neoplasms / surgery
Risk
Treatment Outcome