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Medline ® Abstract for Reference 78

of '胰腺癌的家系危险因素和高风险患者的筛查'

Feasibility and yield of screening in relatives from familial pancreatic cancer families.
Ludwig E, Olson SH, Bayuga S, Simon J, Schattner MA, Gerdes H, Allen PJ, Jarnagin WR, Kurtz RC
Am J Gastroenterol. 2011;106(5):946. Epub 2011 Apr 5.
OBJECTIVES: Pancreatic adenocarcinoma is a lethal disease. Over 80% of patients are found to have metastatic disease at the time of diagnosis. Strategies to improve disease-specific outcome include identification and early detection of precursor lesions or early cancers in high-risk groups. In this study, we investigate whether screening at-risk relatives of familial pancreatic cancer (FPC) patients is safe and has significant yield.
METHODS: We enrolled 309 asymptomatic at-risk relatives into our Familial Pancreatic Tumor Registry (FPTR) and offered them screening with magnetic resonance cholangiopancreaticogram (MRCP) followed by endoscopic ultrasound (EUS) with fine needle aspiration if indicated. Relatives with findings were referred for surgical evaluation.
RESULTS: As of 1 August 2009, 109 relatives had completed at least one cycle of screening. Abnormal radiographic findings were present on initial screening in 18/109 patients (16.5%), 15 of whom underwent EUS. A significant abnormality was confirmed in 9of 15 patients, 6 of whom ultimately had surgery for an overall diagnostic yield of 8.3% (9/109). Yield was greatest in relatives>65 years old (35%, 6/17) when compared with relatives 55-65 years (3%, 1/31) and relatives<55 years (3%, 2/61).
CONCLUSIONS: Screening at-risk relatives from FPC families has a significant diagnostic yield, particularly in relatives>65 years of age, confirming prior studies. MRCP as initial screening modality is safe and effective.
Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. ludwige@mskcc.org