Pancreatic Cancer Screening in a Population at High Risk
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 700
- 试验地点
- 2
- 主要终点
- Number of participants with newly diagnosed pancreatic ductal adenocarcinoma
研究概览
简要总结
Pancreatic cancer is one of the diseases with the worst prognosis, which is mainly due to the initial asymptomatic prognosis. Unfortunately, the incidence of this disease in the Czech Republic is still increasing. In a certain proportion of patients, it is possible to predict the disease, e.g. due to family burdens. Regular follow-up of such individuals is the subject of the SCREPAN study: "Pancreatic Cancer Screening in High-Risk Persons".
详细描述
Pancreatic ductal adenocarcinoma (PDAC) is one of the cancers with the worst prognosis. Mortality in this disease is almost equal to the incidence. In the Czech Republic, the incidence of this cancer has an upward trend, in 2017, 21.2 new cases per 100,000 people were reported, which represents a more than double increase compared to the data from the 1970s.
Pancreatic cancer is associated with an extremely poor prognosis for several reasons. It is usually diagnosed at an advanced stage, which is often due to the asymptomatic course of the disease or non-specific symptoms, the lack of sensitive and specific tumor markers, and difficult diagnosis by imaging methods in the early stages. Five-year survival, regardless of clinical stage, is between 7-9%.
Resectable disease is diagnosed in only 10% of patients, in which the 5-year survival rate is 37 %, locally advanced unresectable disease is detected in about 30 % of patients with a 5-year survival of 12 %, and metastatic disease is found in about 60 % of patients, with a 5-year survival rate of only around 3 %.
The poor prognosis of this disease is also due to the limited possibilities of screening and curative intervention for a short "lead time" in rapidly metastatic disease.
Pancreatic cancer screening is not suitable for the non-selected population. On the contrary, it is important for individuals with a high risk of developing this disease. In these subjects, early diagnosis during screening demonstrated a higher number of curative resections and longer survival.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Screening
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •willing to participate in the study
- •arms specific criteria:
- •chronic pancreatic disease in the context of cystic fibrosis or chronic pancreatitis
- •confirmed Peutz-Jegherson syndrome (mutSTK11) + age over 35 years or 10 years earlier than pancreatic ductal adenocarcinoma was diagnosed in the youngest family member
- •familial melanoma syndrome (mutCDKN2A) + age over 40 years or 10 years before pancreatic ductal adenocarcinoma was diagnosed in the youngest family member
- •confirmed hereditary pancreatitis (mutPRSS1) + age over 40 years or 20 years after the first attack
- •confirmed diagnosis of hereditary syndrome (Lynch syndrome /mutMLH1, mutMSH2, mutMSH6, mutPMS2, mutEPCAM/, HBOC /mutBRCA1, mutBRCA2, mutPALB2, mutATM/, familial adenomatous polyposis /mutAPC/, Li-Fraumeni syndrome /mutTP53/)
- •at least one relative with a diagnosis of pancreatic ductal adenocarcinoma in family anamnesis at the same time (Grade I or II relative)
- •age over 50 years, or 10 years before the pancreatic ductal adenocarcinoma was diagnosed in the youngest relative - which comes first
- •positive family anamnesis of pancreatic ductal adenocarcinoma without hereditary syndrome context
- •age 50+ or 10 years earlier than the youngest relative with pancreatic ductal adenocarcinoma - screening is recommended for all first-degree relatives of affected family members
排除标准
- •Inability to undergo radical curative surgery for a pancreatic tumor.
- •Inability to undergo scheduled imaging examinations.
- •Incurable malignant cancer.
研究组 & 干预措施
A - chronic pancreatitis
Chronic pancreatitis, due to cystic fibrosis
干预措施: endoscopic ultrasonography (Procedure)
A - chronic pancreatitis
Chronic pancreatitis, due to cystic fibrosis
干预措施: magnetic resonance (Procedure)
A - chronic pancreatitis
Chronic pancreatitis, due to cystic fibrosis
干预措施: laboratory examination (Diagnostic Test)
B1 - genetic predisposition (STK11, CDKN2A, PRSS1)
Persons with a confirmed diagnosis of Peutz-Jeghers syndrome (STK11 mutation) or familial melanoma syndrome (CDKN2A mutation), hereditary pancreatitis (PRSS1 mutation)
干预措施: endoscopic ultrasonography (Procedure)
B1 - genetic predisposition (STK11, CDKN2A, PRSS1)
Persons with a confirmed diagnosis of Peutz-Jeghers syndrome (STK11 mutation) or familial melanoma syndrome (CDKN2A mutation), hereditary pancreatitis (PRSS1 mutation)
干预措施: magnetic resonance (Procedure)
B1 - genetic predisposition (STK11, CDKN2A, PRSS1)
Persons with a confirmed diagnosis of Peutz-Jeghers syndrome (STK11 mutation) or familial melanoma syndrome (CDKN2A mutation), hereditary pancreatitis (PRSS1 mutation)
干预措施: laboratory examination (Diagnostic Test)
B2 - genetic predisposition of hereditary syndromes
Persons with a confirmed diagnosis of hereditary syndromes and at the same time with the condition of at least one relative of the first or second degree with a diagnosis of pancreatic ductal adenocarcinoma in family anamnesis; i.e. Lynch syndrome (mut: MLH1, MSH2, MSH6 a PMS2, EPCAM), HBOC (mut: BRCA1, BRCA2, PALB2, ATM), familial adenomatous polyposis (mut: APC), Li-Fraumeni syndrome (mut: TP53)
干预措施: endoscopic ultrasonography (Procedure)
B2 - genetic predisposition of hereditary syndromes
Persons with a confirmed diagnosis of hereditary syndromes and at the same time with the condition of at least one relative of the first or second degree with a diagnosis of pancreatic ductal adenocarcinoma in family anamnesis; i.e. Lynch syndrome (mut: MLH1, MSH2, MSH6 a PMS2, EPCAM), HBOC (mut: BRCA1, BRCA2, PALB2, ATM), familial adenomatous polyposis (mut: APC), Li-Fraumeni syndrome (mut: TP53)
干预措施: magnetic resonance (Procedure)
B2 - genetic predisposition of hereditary syndromes
Persons with a confirmed diagnosis of hereditary syndromes and at the same time with the condition of at least one relative of the first or second degree with a diagnosis of pancreatic ductal adenocarcinoma in family anamnesis; i.e. Lynch syndrome (mut: MLH1, MSH2, MSH6 a PMS2, EPCAM), HBOC (mut: BRCA1, BRCA2, PALB2, ATM), familial adenomatous polyposis (mut: APC), Li-Fraumeni syndrome (mut: TP53)
干预措施: laboratory examination (Diagnostic Test)
C - positive family anamnesis
Persons with positive family anamnesis of pancreatic ductal adenocarcinoma without proven hereditary syndrome
干预措施: endoscopic ultrasonography (Procedure)
C - positive family anamnesis
Persons with positive family anamnesis of pancreatic ductal adenocarcinoma without proven hereditary syndrome
干预措施: magnetic resonance (Procedure)
C - positive family anamnesis
Persons with positive family anamnesis of pancreatic ductal adenocarcinoma without proven hereditary syndrome
干预措施: laboratory examination (Diagnostic Test)
结局指标
主要结局
Number of participants with newly diagnosed pancreatic ductal adenocarcinoma
时间窗: From date of subject enrollment annualy in determined examinations according to the protocol schedule until the date of PDAC diagnosis or up to 60 months of subject participation in the study
Number of participants (in risk population) with newly diagnosed pancreatic cancer
次要结局
- Screening methods cost-effectiveness(through study completion, an average of 1 year)
- KRAS mutation status evaluation(From the date of subject enrollment annualy in determined examinations according to the protocol schedule until the date of PDAC diagnosis or up to 60 months of subject participation in the study)
- Methods yield comparison(through study completion, an average of 1 year)