Dhruv Pratap Singh1, Shannon Sheedy2, Ajit H Goenka3, Michael Wells4, Nam Ju Lee5, John Barlow6, Ayush Sharma7, Harika Kandlakunta8, Shruti Chandra9, Sushil Kumar Garg10, Shounak Majumder11, Michael J Levy12, Naoki Takahashi13, Suresh T Chari14. 1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: druvsingh@gmail.com. 2. Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: sheedy.shannon@mayo.edu. 3. Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: goenka.ajit@mayo.edu. 4. Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: wells.michael@mayo.edu. 5. Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: lee.namju@mayo.edu. 6. Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: barlow.john@mayo.edu. 7. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: drayusharma@gmail.com. 8. Division of Internal Medicine, Staten Island University Hospital, New York, Staten Island, USA. Electronic address: kharika0892@gmail.com. 9. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: chandra.shruti@mayo.edu. 10. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: garg.sushil@mayo.edu. 11. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: majumder.shounak@mayo.edu. 12. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: levy.michael@mayo.edu. 13. Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: takahashi.naoki@mayo.edu. 14. Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: stchari@mdanderson.org.
Abstract
BACKGROUND: The frequency, nature and timeline of changes on thin-slice (≤3 mm) multi-detector computerized tomography (CT) scans in the pre-diagnostic phase of pancreatic ductal adenocarcinoma (PDAC) are unknown. It is unclear if identifying imaging changes in this phase will improve PDAC survival beyond lead time. METHODS: From a cohort of 128 subjects (Cohort A) with CT scans done 3-36 months before diagnosis of PDAC we developed a CTgram defining CT Stages (CTS) I through IV in the radiological progression of pre-diagnostic PDAC. We constructed Cohort B of PDAC resected at CTS I and II and compared survival in CTS I and II in Cohort A (n = 22 each; control natural history cohort) vs Cohort B (n = 33 and 72, respectively; early interception cohort). RESULTS: CTs were abnormal in 16% and 85% at 24-36 and 3-6 months respectively, before PDAC diagnosis. The PDAC CTgram stages, findings and median lead times (months) to clinical diagnosis were: CTS I: Abrupt duct cut-off/duct dilatation (-12.8); CTS II: Low density mass confined to pancreas (-9.5), CTS III: Peri-pancreatic infiltration (-5.8), CTS IV: Distant metastases (only at diagnosis). PDAC survival was better in cohort B than in cohort A despite inclusion of lead time in Cohort A: CTS I (36 vs 17.2 months, p = 0.03), CTS II (35.2 vs 15.3 months, p = 0.04). CONCLUSION: Starting 12-18 months before PDAC diagnosis, progressive and increasingly frequent changes occur on CT scans. Resection of PDAC at the time of pre-diagnostic CT changes is likely to provide survival benefit beyond lead time.
BACKGROUND: The frequency, nature and timeline of changes on thin-slice (≤3 mm) multi-detector computerized tomography (CT) scans in the pre-diagnostic phase of pancreatic ductal adenocarcinoma (PDAC) are unknown. It is unclear if identifying imaging changes in this phase will improve PDAC survival beyond lead time. METHODS: From a cohort of 128 subjects (Cohort A) with CT scans done 3-36 months before diagnosis of PDAC we developed a CTgram defining CT Stages (CTS) I through IV in the radiological progression of pre-diagnostic PDAC. We constructed Cohort B of PDAC resected at CTS I and II and compared survival in CTS I and II in Cohort A (n = 22 each; control natural history cohort) vs Cohort B (n = 33 and 72, respectively; early interception cohort). RESULTS: CTs were abnormal in 16% and 85% at 24-36 and 3-6 months respectively, before PDAC diagnosis. The PDAC CTgram stages, findings and median lead times (months) to clinical diagnosis were: CTS I: Abrupt duct cut-off/duct dilatation (-12.8); CTS II: Low density mass confined to pancreas (-9.5), CTS III: Peri-pancreatic infiltration (-5.8), CTS IV: Distant metastases (only at diagnosis). PDAC survival was better in cohort B than in cohort A despite inclusion of lead time in Cohort A: CTS I (36 vs 17.2 months, p = 0.03), CTS II (35.2 vs 15.3 months, p = 0.04). CONCLUSION: Starting 12-18 months before PDAC diagnosis, progressive and increasingly frequent changes occur on CT scans. Resection of PDAC at the time of pre-diagnostic CT changes is likely to provide survival benefit beyond lead time.
Authors: Suresh T Chari; Anirban Maitra; Lynn M Matrisian; Eva E Shrader; Bechien U Wu; Avinash Kambadakone; Ying-Qi Zhao; Barbara Kenner; Jo Ann S Rinaudo; Sudhir Srivastava; Ying Huang; Ziding Feng Journal: Contemp Clin Trials Date: 2021-12-23 Impact factor: 2.226
Authors: Barbara Kenner; Suresh T Chari; David Kelsen; David S Klimstra; Stephen J Pandol; Michael Rosenthal; Anil K Rustgi; James A Taylor; Adam Yala; Noura Abul-Husn; Dana K Andersen; David Bernstein; Søren Brunak; Marcia Irene Canto; Yonina C Eldar; Elliot K Fishman; Julie Fleshman; Vay Liang W Go; Jane M Holt; Bruce Field; Ann Goldberg; William Hoos; Christine Iacobuzio-Donahue; Debiao Li; Graham Lidgard; Anirban Maitra; Lynn M Matrisian; Sung Poblete; Laura Rothschild; Chris Sander; Lawrence H Schwartz; Uri Shalit; Sudhir Srivastava; Brian Wolpin Journal: Pancreas Date: 2021-03-01 Impact factor: 3.243