Time interval from last visit to imaging diagnosis influences outcome in pancreatic adenocarcinoma: A regional population-based study on linked medico-administrative and clinical data

Diagnostic delay at diagnosis and time-to-treatment influence overall survival of pancreatic cancer patients

BACKGROUND

Pancreatic adenocarcinoma (PDAC) presents with nonspecific symptoms, leading to long diagnostic delays and time-to-treatment. Data on the effects of diagnostic delay and time-to-treatment on the prognosis of PDAC patients are limited, dated and heterogeneous.

AIMS

To investigate whether diagnostic delay, time-to-treatment, or diagnostic delay + time-to-treatment (overall delay) impact overall survival (OS) and whether they differ in patients followed up at a tertiary referral center compared to community hospitals.

METHODS

This was a single-center prospective cohort of consecutive patients with PDAC, recording demographics, presenting symptoms, stage, treatments, and survival.

RESULTS

A total of 282 patients were included. Diagnostic delay>49 days was significantly associated with a higher risk of death in univariate (HR 1.627; 95 % CI 1.15-2.28; p = 0.005) but not in multivariate analysis, whereas overall delay>104 days was significantly associated with a higher risk of death in both univariate (HR 1.83; 95 %CI 1.29-2.61; p = 0.0008) and multivariate (HR, 1.63; 95 % CI, 1.13-2.34; p = 0.008) analyses. Patients who were entirely cared for in tertiary center presented a significantly shorter median time-to-treatment (49 vs. 56 days; p = 0.048) than those in community hospitals.

CONCLUSION

Prolonged diagnostic and overall delays seem to impair the survival of patients with PDAC. While diagnostic delay might be reduced with higher awareness of specific warning symptoms, the overall delay can be reduced through specific and faster dedicated therapeutic pathways in referral centers.

Incidence and mortality of prostate cancer in France from 2010 to 2021, using a real-life database (National Health Data System - SNDS) - the CaPCo Study

BACKGROUND AND OBJECTIVE

Prostate cancer (PCa) was the leading incident cancer and 3rd leading cause of cancer death in men in France in 2015 with inter-regional disparities. The objectives were to describe PCa incidence and mortality in France and by region, using real life data from the National Health Data System and to identify the factors associated with all-cause or PCa-specific mortality.

METHODS

Men aged ≥ 18years hospitalized and/or on long-term care for PCa (ICD-10 code C61) in France between 2010 and 2021 were included. An incident case was defined by the absence of any cancer in the five years preceding the first coding. Incidence and mortality estimates were age-standardized: France 2018f standardized rates (FSR), all-cause mortality (SMR) and PCa-specific mortality (SMRspe). Factors associated with death were identified using cause-specific Cox models.

RESULTS

The mean annual incidence was 47,081cases/year (FSR:179.6/100,000men), increasing over the period except 2020. All-cause mortality was 20,259 deaths/year (77.3/100,000men), and PCa-specific mortality was 7,265 deaths/year (27.7/100,000men). A PCa-specific mortality excess was found in Centre-Val-de-Loire (SMRspe = 1.21), Bretagne (1.18), Hauts-de-France (1.17) Normandie (1.15). After adjustment, significant PCa mortality excess was observed in Bretagne (HR = 1,29;95%IC[1.09-1.46]) and Hauts-de-France (HR = 1.19[1.03-1.34]). The other factors associated with death were an age ≥ 60years, an increasing comorbidity index, metastatic disease at onset (major weight in specific mortality with hazard ratio HR = 16.1[15.2-17.0]), precariousness, affiliation to the agricultural scheme, and the COVID period in all-cause mortality.

CONCLUSION

This study updated incidence and mortality data in France. It showed differences in mortality between regions in France. The adjustment moderates regional findings based on raw mortality data.

Echoendoscopic ultrasound pancreatic adenocarcinoma diagnosis and theranostic approach: should KRAS mutation research be recommended in everyday practice?

Background

The impact of KRAS mutation testing on pancreatic ductal adenocarcinoma (PDAC) samples by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for reducing the need to repeat EUS-FNA has been demonstrated. Such testing however is not part of standard practice for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB).

Objectives

We aim to analyse the proportion of non-contributive samples by EUS-FNB and to evaluate the impact of KRAS mutation testing on the diagnosis, theranostics and survival.

Design

In this retrospective study, the impact on diagnosis and survival of KRAS testing for contributive and non-contributive samples by EUS-FNB was analysed.

Methods

The EUS-FNB samples, combined with KRAS testing using the Idylla® technique on liquid-based cytology from patients with PDAC between February 2019 and May 2023, were retrospectively reviewed. The cytology results were classified according to the guidelines of the World Health Organization System for Reporting Pancreaticobiliary Cytopathology (WHOSRPC).

Results

A total of 85 EUS-FNB specimens were reviewed. In all, 25 EUS-FNB samples did not lead to a formal diagnosis of PDAC according to the WHOSRPC (30.2%). Out of these 25, 11 (44%) could have been considered positive for a PDAC diagnosis thanks to the KRAS mutation test without carrying out further diagnosis procedures. The sensitivity of KRAS mutation testing using the Idylla technique was 98.6%. According to the available data, survival rates were not statistically different depending on the type of mutation.

Conclusion

KRAS mutation testing on liquid-based cytology using the Idylla or equivalent technique, combined with the PDAC EUS-FNB sample, should become a standard for diagnosis to avoid delaying treatment by doing another biopsy. Furthermore, knowledge of the KRAS status from treatment initiation could be used to isolate mutations requiring targeted treatments or inclusion in clinical research trials, especially for wild-type KRAS PDAC.