surveillance in patients with chronic pancreatitis or ... · - early onset of chronic pancreatitis...
TRANSCRIPT
Surveillance in patients with chronic pancreatitis or hereditary risks
European Digestive Cancer Days 201726th September
Prague
J RosendahlUniversitaumltsklinik fuumlr Innere Medizin I
Universitaumltsklinikum Halle (Saale)
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Tod Malignome und Komorbiditaumlten bei CP
Bang et al Gastroenterology 2014
- Retrospective cohort study (1995-2010)
- 11972 CP patients (71814 person years)
119720 controls (917436 person years)
- 46 patients died vs 13 controls (HR 50 95 CI 48-52)
- Cancer deaths 102 pat vs 33 controls (HR 69 95 CI 75-118)
Cancer types in Chronic Pancreatitis (CP) patients
Risiko zu sterben - Todesrate
Bang et al Gastroenterology 2014
Risk of death in CP patients
Malignome bei CP
Bang et al Gastroenterology 2014
Are other cancer types even more important
Raimondi et al Best Pract Res Clin Gastroenterol 2010
Ku
mu
lati
ve In
zid
enz
()
Pancreatic cancer risk ndash CP
Relative risk (95 CI)
RR 133 (61-289)
RR 690 (564-844)
Kirkekacircrd et al Am J Gastroenterol 2017
Pancreatic cancer risk ndash CP (lag period)
1616
79
35
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Tod Malignome und Komorbiditaumlten bei CP
Bang et al Gastroenterology 2014
- Retrospective cohort study (1995-2010)
- 11972 CP patients (71814 person years)
119720 controls (917436 person years)
- 46 patients died vs 13 controls (HR 50 95 CI 48-52)
- Cancer deaths 102 pat vs 33 controls (HR 69 95 CI 75-118)
Cancer types in Chronic Pancreatitis (CP) patients
Risiko zu sterben - Todesrate
Bang et al Gastroenterology 2014
Risk of death in CP patients
Malignome bei CP
Bang et al Gastroenterology 2014
Are other cancer types even more important
Raimondi et al Best Pract Res Clin Gastroenterol 2010
Ku
mu
lati
ve In
zid
enz
()
Pancreatic cancer risk ndash CP
Relative risk (95 CI)
RR 133 (61-289)
RR 690 (564-844)
Kirkekacircrd et al Am J Gastroenterol 2017
Pancreatic cancer risk ndash CP (lag period)
1616
79
35
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Tod Malignome und Komorbiditaumlten bei CP
Bang et al Gastroenterology 2014
- Retrospective cohort study (1995-2010)
- 11972 CP patients (71814 person years)
119720 controls (917436 person years)
- 46 patients died vs 13 controls (HR 50 95 CI 48-52)
- Cancer deaths 102 pat vs 33 controls (HR 69 95 CI 75-118)
Cancer types in Chronic Pancreatitis (CP) patients
Risiko zu sterben - Todesrate
Bang et al Gastroenterology 2014
Risk of death in CP patients
Malignome bei CP
Bang et al Gastroenterology 2014
Are other cancer types even more important
Raimondi et al Best Pract Res Clin Gastroenterol 2010
Ku
mu
lati
ve In
zid
enz
()
Pancreatic cancer risk ndash CP
Relative risk (95 CI)
RR 133 (61-289)
RR 690 (564-844)
Kirkekacircrd et al Am J Gastroenterol 2017
Pancreatic cancer risk ndash CP (lag period)
1616
79
35
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Risiko zu sterben - Todesrate
Bang et al Gastroenterology 2014
Risk of death in CP patients
Malignome bei CP
Bang et al Gastroenterology 2014
Are other cancer types even more important
Raimondi et al Best Pract Res Clin Gastroenterol 2010
Ku
mu
lati
ve In
zid
enz
()
Pancreatic cancer risk ndash CP
Relative risk (95 CI)
RR 133 (61-289)
RR 690 (564-844)
Kirkekacircrd et al Am J Gastroenterol 2017
Pancreatic cancer risk ndash CP (lag period)
1616
79
35
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Malignome bei CP
Bang et al Gastroenterology 2014
Are other cancer types even more important
Raimondi et al Best Pract Res Clin Gastroenterol 2010
Ku
mu
lati
ve In
zid
enz
()
Pancreatic cancer risk ndash CP
Relative risk (95 CI)
RR 133 (61-289)
RR 690 (564-844)
Kirkekacircrd et al Am J Gastroenterol 2017
Pancreatic cancer risk ndash CP (lag period)
1616
79
35
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Raimondi et al Best Pract Res Clin Gastroenterol 2010
Ku
mu
lati
ve In
zid
enz
()
Pancreatic cancer risk ndash CP
Relative risk (95 CI)
RR 133 (61-289)
RR 690 (564-844)
Kirkekacircrd et al Am J Gastroenterol 2017
Pancreatic cancer risk ndash CP (lag period)
1616
79
35
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Kirkekacircrd et al Am J Gastroenterol 2017
Pancreatic cancer risk ndash CP (lag period)
1616
79
35
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Histological results of operated patients with inherited CP
Rebours et al Clin Gastroenterol Hepatol 2010
Median 24 years 6221211
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Howes et al Clin Gastroenterol Hepatol 2004
Dia
gno
sed
(
)n=418
EUROPAC ndash Risk to develop Pancreatic Carcinoma
Age (years)
59
22
19
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Pancreatic cancer ndash CP and Smoking
Lowenfels et al JAMA 2001
Age
at
dia
gno
sis
(yea
rs)
Ever smoker Never smoker
Onset of the
disease 20 years
earlier
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Pankreaskarzinom - CP
- Cancer risk in Chronic Pancreatitis patients
- Is Pancreatic Cancer a real burden
- Influence of Aetiology
- Lag between Chronic Pancreatitis and Cancer development
- Hereditary Chronic Pancreatitis
- Precursor lesions ndash Early detectable
- Mutations and Pancreatic Cancer development
- Surveillance strategies
- Lessons from familial Pancreatic Cancer
Surveillance in patients with chronic pancreatitis or hereditary risks
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Screening seems feasible
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Endoscopic ultrasound in CP
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Screening ndash Comparison with familial Pancreatic cancer
Bartsch et al Fam Cancer 2013
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Surveillance ndash Who should be screened
Vasen et al J Clin Oncol 2016
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Pancreatic Cancer in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
13178 (73)Average follow-up 44 month
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
(Sporadic Pancreatic Cancer approx 4-7)
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Overall survival in CDKN2Ap16 mutation carriers
Vasen et al J Clin Oncol 2016
5-year survival rate24
Familial Pancreatic Cancer group
2214 (09) Pancreatic Tumor(one Pancreatic Cancer)
13214 (61) underwent resection
4 had High grade lesions
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Signature of metabolites ndash A promising approach
Mayerle et al GUT 2017
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Thrombospondin-2 and CA19-9 ndash A promising approach
Kim et al Sci Transl Med 2017
Combining CA19-9 and THBS2Sensitivity 87Specificity 98
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Urine peptide panel ndash A promising approach
Schoumlnemeier et al Pancreas 2016
7282
gt37 UmL
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Pankreaskarzinom - CP
Conclusion
- Pancreatic Cancer is a real burden for Chronic Pancreatitis patients
- Early onset of Chronic Pancreatitis increases risk to develop
Pancreatic Cancer
- Surveillance strategies need improvement as demonstrated in
familial Pancreatic Cancer
- Are new Biomarkers the solution - Relatives Risiko 57 (95 CI
Surveillance in patients with chronic pancreatitis or hereditary risks
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Thank you
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Mayerle et al GUT 2017
Signature of metabolites ndash A promising approach
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Familiaumlres Pankreaskarzinom - Screening
Habbe et al Chirurg 2008
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient
Gut 2016 Aug65(8)1314-21 doi 101136gutjnl-2015-311098 Epub 2016 May 24
Refinement of screening for familial pancreatic cancer
Bartsch DK1 Slater EP1 Carrato A2 Ibrahim IS3 Guillen-Ponce C2 Vasen HF3 Matthaumli E1 Earl J2 Jendryschek FS1 Figiel J4 Steinkamp M5
Ramaswamy A6 Vaacutezquez-Sequeiros E7 Muntildeoz-Beltran M8 Montans J9 Mocci E2 Bonsing BA10 Wasser M11 Kloumlppel G12 Langer P13 Fendrich V1
Gress TM5
Author information
Abstract
OBJECTIVE
Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic
ductal adenocarcinoma PDAC) However the age to begin screening and the optimal screening protocol remain to be determined
METHODS
IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective
screening programmes at three tertiary referral centres The diagnostic yield according to age and different screening protocols was analysed
RESULTS
253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-
152) months 134 (53) IAR revealed pancreatic lesions on imaging mostly cystic (94) on baseline or follow-up screening Lesions were significantly
more often identified in IAR above the age of 45 years (plt00001) In 21 IAR who underwent surgery no significant lesions (PDAC pancreatic
intraepithelial neoplasia (PanIN) 3 lesions high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years
Potentially relevant lesions (multifocal PanIN2 lesions lowmoderate-grade branch-duct IPMNs) occurred also significantly more often after the age of
50 years (13 vs 2 plt00004) The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS
(n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at
ge24 months intervals (n=30)
CONCLUSIONS
It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years MRI-based screening supplemented by EUS at
baseline and every 3rd year or when changes in MRI occur appears to be efficient