Identification and surveillance of high-risk groups for pancreatic cancer

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a representative malignancy with a poor prognosis, and its incidence has been increasing in recent years. To improve outcomes, it is essential to diagnose PDAC at an early, resectable stage. Various efforts and clinical trials designed to overcome these clinical challenges have been reported. Given that PDAC often remains asymptomatic until it progresses, early detection requires efficient surveillance of high-risk individuals and the establishment of reliable biomarkers for early diagnosis.Intraductal papillary mucinous neoplasm (IPMN) has been identified not only as a premalignant lesion but also as a high-risk condition for the development of concomitant PDAC. The 2024 revision of the international evidence-based guidelines for IPMN (Kyoto Guidelines) discusses the risk of PDAC in patients with IPMN and provides recommendations for surveillance strategies. However, to date, age remains the only recognized risk factor for concomitant PDAC with IPMNs. Therefore, continued surveillance is required for the majority of pancreatic cysts, even among patients with low-grade IPMN. To enhance early diagnosis of PDAC, further refinement of high-risk groups within cohorts of patients with IPMN or pancreatic cysts is urgently needed. In addition to IPMN, familial pancreatic cancer and hereditary tumor syndromes are also recognized as genetic predispositions that place patients at high risk of developing PDAC. For these populations, implementing regular surveillance in combination with the development of novel biomarkers is expected to pave the way for the early diagnosis of PDAC in the future.