Imaging leads to less invasive surveillance testing in patients with pancreatic cancer, but does not result in improved survival, according to research published August 3 in JAMA Network Open.
While CT use remained stable and MRI use increased in these patients during a 16-year study period, endoscopic ultrasound use steadily decreased, wrote a team led by Bechien, Wu, MD, from Kaiser Permanente Los Angeles Medical Center in California. Despite these trends in imaging use, pancreatic cancer survival rates did not increase.
“For our radiology colleagues, I think this helps to reinforce the utility of image-based risk stratification as an initial step to identify patients that may benefit from further invasive testing,” Wu told AuntMinnie.
Medical societies are increasingly calling for risk stratification and deescalation of invasive tests for patients with pancreatic cystic neoplasms that do not have high-risk features.
Wu and co-authors studied trends in surveillance testing for patients pancreatic cystic neoplasms. They focused on corresponding changes in pancreatic cancer stage at diagnosis or survival.
The study included data collected between 2006 and 2022 from 13,258 patients diagnosed with prostate cystic neoplasms who received care within Kaiser Permanente Southern California.
Over the study period, CT was the most used modality. But MRI gained ground beginning in 2014. And endoscopic ultrasound use declined over time, including significant reduction between 2006 and 2013 followed by continued gradual decreases in later years.
A.) Rate of imaging utilization during surveillance by year, 2008 to 2022. B.) Rate of endoscopic ultrasound (EUS) and pancreatic surgery per 100 person years, 2008 to 2022.JAMA
During a median follow-up of 3.1 years, 149 patients (1.1%) were diagnosed with pancreatic cancer. This corresponds to an incidence rate of 279.6 per 100,000 person-years.
The researchers also reported a median time from index surveillance date to cancer diagnosis of 1.6 years. Cumulative incidence for prostate cancer included the following: 0.004 at one year, 0.008 at two years, 0.009 at three years, 0.011 at five years was 0.011, and 0.02 at 10 years.
At diagnosis, 52 patients (34.9%) had in situ or localized disease, 44 (29.5%) had regional disease, and 47 (31.5%) had metastatic disease. The team reported a median survival of 10 months among patients diagnosed with prostate cancer.
Cancer stage showed significant ties with survival on multivariable Cox regression analysis. Distant cancer stage on mortality achieved a hazard ratio (HR) of 2.96. However, practice era did not have significant associations with survival. From 2013 to 2018, the HR was 0.84 while from 2019 to 2022, it was 0.91.
Wu said no improvement in cancer-related survival suggests that improved strategies are still needed for early detection and intervention for patients who experience malignant transformation of their pancreatic cyst.
He told AuntMinnie that molecular cyst fluid analysis could be a “very promising” approach to better characterize pancreatic cysts with respect to their malignant potential.
Wu also said the group and other researchers will explore how AI could help integrate multiple layers of clinical data. The goals for this future research include improving image interpretation and advancing cyst molecular analysis.
“We anticipate this will define the next era in the care of patients with pancreatic cysts where we can hopefully intervene early enough in the rare patient that develops cancer in relation to their cyst while continuing to spare the majority of patients unnecessary invasive testing,” he said.
Read the full study here.