LAUSR

BACKGROUND & AIMS Recent pancreatic cancer surveillance programs of high-risk individuals have reported improved outcomes. This study assessed to what extent outcomes of pancreatic ductal adenocarcinoma (PDAC) in patients with a CDKN2A/p16 pathogenic variant (PV) diagnosed under surveillance are better as compared to PDAC patients diagnosed outside surveillance. METHODS In a propensity score matched cohort using data from the Netherlands Cancer Registry (NCR), we compared resectability, stage and survival between patients diagnosed under surveillance with non-surveillance PDAC patients. Survival analyses were adjusted for potential effects of lead time. RESULTS Between January 2000 and December 2020, 43 762 patients with PDAC were identified from the NCR. Thirty-one patients with PDAC under surveillance were matched in a 1:5 ratio with 155 non-surveillance patients based on age at diagnosis, sex, year of diagnosis, and tumor location. Outside surveillance, 5.8% of the cases had stage I cancer, as compared to 38.7% of surveillance PDAC patients (OR 0.09; 95% CI, 0.04 - 0.19). In total, 18.7% of non-surveillance patients vs. 71.0% of surveillance patients underwent a surgical resection (OR 10.62; 95% CI, 4.56 - 26.63). Patients in surveillance had a better prognosis, reflected by a 5-year survival of 32.4% and a median overall survival (OS) of 26.8 months vs. 4.3% 5-year survival and 5.2 months median OS in non-surveillance patients (HR 0.31, 95% CI 0.19 - 0.50). For all adjusted lead times, survival remained significantly longer in surveillance patients than in non-surveillance patients. CONCLUSION Surveillance for PDAC in carriers of a CDKN2A/p16 PV results in earlier detection, increased resectability and improved survival as compared to non-surveillance PDAC patients.