Retrospective cohort study of surveillance testing and pancreatic cancer incidence among patients with pancreatic cysts

A retrospective cohort study at Kaiser Permanente Southern California evaluated temporal trends in surveillance testing for adult patients with pancreatic cystic neoplasms (PCNs) and assessed corresponding changes in pancreatic cancer (PC) stage at diagnosis or survival. Between 2006 and 2022 a total of 13,258 patients were diagnosed with PCN. The median age was 70.6 years (IQR 61.1-78.6); 62.7% were female. Over the study period, computed tomography (CT) remained the predominant imaging modality; however, magnetic resonance imaging (MRI) utilization increased steadily beginning in 2014. Rates of endoscopic ultrasound (EUS) decline substantially over time with marked reduction between 2006 and 2013 followed by continued gradual decreases in later year. Pancreatic surgery rates were low throughout the study period and declined further beginning in 2015. During a median follow-up of 3.1 years (IQR 1.2-5.8), 149 patients (1.1%) were diagnosed with PC, corresponding to an incidence rate of 279.6 per 100,000 person-years. Median time from index surveillance date to cancer diagnosis was 1.6 years. Cumulative incidence of PC was 0.004 at 1 year and 0.020 at 10 years. At diagnosis 34.9% had in situ or localized disease, 29.5% had regional disease, and 31.5% had metastatic disease. Median survival among patients diagnosed with PC was 10 months (IQR 2-32). The authors conclude that while these findings support the safety of contemporary surveillance strategies that emphasize selective use of invasive testing, a lack of improvement in survival among patients who developed PC underscores the potential limitations of imaging-based risk stratification strategies.