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Pankreaskarzinom – Screening oder Surveillance: Was ergibt Sinn?

Pancreatic cancer—screening or surveillance: which makes sense?

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best practice onkologie Aims and scope

Zusammenfassung

Hintergrund

Trotz einer steten Verbesserung diagnostischer und therapeutischer Verfahren versterben, global wie national betrachtet, jährlich fast ebenso viele Personen am Pankreaskarzinom, wie daran erkranken. Voraussetzung für eine potenziell kurative Resektion ist die Diagnose in einem frühen Tumorstadium. Betroffene mit entsprechendem genetischen und/oder familiären Risikoprofil sollten überwacht werden und in strukturierte Surveillance-Programmen eingeschlossen werden.

Fragestellung

Wie ist der Status quo der aktuellen Screening- und Surveillance-Konzepte für das duktale Adenokarzinom des Pankreas (PDAC)?

Material und Methoden

Es wurde eine selektive Literaturrecherche der aktuellen nationalen und internationalen Leitlinien und der zugrunde liegenden Literatur durchgeführt.

Ergebnisse

Etwa die Hälfte aller Pankreaskarzinome wird auch in Hochrisikopatientenkohorten im Rahmen von Surveillance-Programmen übersehen. Magnetresonanztomographie und Endosonographie ergänzt um CA19‑9 (± HbA1c) sind nicht spezifisch genug, um eine robuste Pankreaskarzinomfrüherkennung sicher zu gewährleisten. Ergänzende Biomarkerpanel werden zukünftig eine entscheidende diagnostische Rolle einnehmen.

Abstract

Background

Despite continuous improvement of diagnostic and therapeutic procedures, the number of new pancreatic ductal adenocarcinoma (PDAC) cases diagnosed annually almost equals the number of PDAC-related deaths. Prerequisite for curative treatment is a resectable tumor at the time of diagnosis. Individuals with genetic and/or familial risk profiles should therefore be screened and included in structured surveillance programs.

Objectives

Description of the status quo and usefulness of current PDAC screening and surveillance concepts.

Methods

A selective literature search of current national and international guidelines including underlying literature was performed.

Results

Nearly half of pancreatic cancer cases are missed by currently available surveillance programs, even in high-risk cohorts. Magnetic resonance imaging and endoscopic ultrasound supplemented by CA19‑9 (± HbA1c) are not accurate enough to ensure robust earlier pancreatic cancer detection. Complementary biomarker panels will take on a crucial diagnostic role in the future.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik II, LMU Klinikum, 81377, München, Deutschland

    Simon Sirtl, Marlies Vornhülz,  Julia Mayerle & Georg Beyer

  2. Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, LMU Klinikum, München, Deutschland

    Felix O. Hofmann

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  1. Simon Sirtl
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  2. Marlies Vornhülz
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  3. Felix O. Hofmann
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  4. Julia Mayerle
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Correspondence to Simon Sirtl or Julia Mayerle.

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Interessenkonflikt

S. Sirtl, M. Vornhülz, F.O. Hofmann, J. Mayerle und G. Beyer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Stephan Schmitz, Köln

Dieser Beitrag erschien zuerst in Gastroenterologie 2022 · 17:375–386 https://doi.org/10.1007/s11377-022-00652-5.

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Sirtl, S., Vornhülz, M., Hofmann, F.O. et al. Pankreaskarzinom – Screening oder Surveillance: Was ergibt Sinn?. best practice onkologie 19, 84–91 (2024). https://doi.org/10.1007/s11654-024-00556-6

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  • DOI: https://doi.org/10.1007/s11654-024-00556-6

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