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DOI: 10.1055/a-1975-2366
Prävention des Pankreaskarzinoms
Prevention of pancreatic cancer![](https://www.thieme-connect.de/media/dmw/202305/lookinside/thumbnails/dmw-19752366_10-1055-a-1975-2366-1.jpg)
Zusammenfassung
Das Pankreaskarzinom nimmt in Deutschland stetig an Häufigkeit zu und stellt aktuell die dritthäufigste tumorbedingte Todesursache dar. Voraussichtlich rückt es bis 2030 auf den 2. Platz und bis 2050 auf den 1. Platz der krebsbedingten Todesfälle vor. Das Pankreasadenokarzinom wird in der überwiegenden Mehrzahl der Fälle spät diagnostiziert und die 5-Jahre-Überlebensrate liegt nach wie vor bei nur 10 %. Zu den beeinflussbaren Risikofaktoren zählen das Tabakrauchen, ein übermäßiges Körpergewicht, der Alkoholkonsum, der Typ-2-Diabetes und das metabolische Syndrom. Der Rauchstopp und die gewollte Gewichtsabnahme (bei Adipositas) können das Pankreaskrebsrisiko um etwa 50 % reduzieren. Zudem ist die Früherkennung des sporadischen Pankreaskarzinoms im Stadium IA – nun mit einem 5-Jahre-Überleben von 80 % – bei Menschen über 50 mit neu diagnostiziertem Diabetes eine realistische Perspektive geworden. Aktuelle Entwicklungen hierzu werden kurz beschrieben.
Abstract
The incidence of pancreatic cancer is rising in Germany. At present pancreatic cancer is the third commonest cause of cancer death but is expected to become the second in 2030 and finally the leading cause of cancer death in 2050. Pancreatic ductal adenocarcinoma (PC) is generally diagnosed at far advanced stages and 5-year-survival has remained poor. Modifiable risk factors of PC are tobacco smoking, excess body weight, alcohol use, type 2-diabetes and the metabolic syndrome. Smoking cessation and -in case of obesity- intentional weight loss can reduce PC risk by as much as 50 %. Early detection of asymptomatic sporadic PC at stage IA – stage IA-PC now has a 5-year-survival rate of about 80 %- has become a realistic chance for people older than 50 years with new-onset diabetes.
Publikationsverlauf
Artikel online veröffentlicht:
27. Februar 2023
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Literatur
- 1 https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Todesursachen/Tabellen/sterbefaelle-krebs-insgesamt.html
- 2 Sung H, Siegel RL, Rosenberg PS. et al. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. Lancet Public Health 2019; 4: e137-e147
- 3 Carioli G, Malvezzi M, Bertuccio P. et al European cancer mortality predictions for the year 2021 with focus on pancreatic and female lung cancer. Ann Oncol 2021; 32: 478-487 DOI: 10.1016/j.annonc.2021.01.006. . Epub 2021 Feb 21. PMID: 336263771A
- 4 Blackford AL, Canto MI, Klein AP. et al. Recent Trends in the Incidence and Survival of Stage 1A Pancreatic Cancer: A Surveillance, Epidemiology, and End Results Analysis. J Natl Cancer Int 2020; 112: 1162-1169
- 5 The Lancet Gastroenterology Hepatology. Pancreatic cancer: a state of emergency?. Lancet Gastroenterol Hepatol 2021; 6 (02) 81 DOI: 10.1016/S2468-1253(20)30397-6.
- 6 https://ourworldindata.org/cancer-death-rates-are-falling-five-year-survival-rates-are-rising
- 7 https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Kurzbeitraege/Archiv2021/2021_2_Kurzbeitraege_datenaktualisierung.html
- 8 https://www.awmf.org/uploads/tx_szleitlinien/032-010OLl_Exokrines-Pankreaskarzinom_2022-01.pdf
- 9 Pereira SP, Oldfield L, Ney A. et al Early detection of pancreatic cancer. Lancet Gastroenterol Hepatol 2020; 5: 698-710 DOI: 10.1016/S2468-1253(19)30416-9. . Epub 2020 Mar 2. PMID: 32135127; PMCID: PMC7380506
- 10 Dbouk M, Brewer Gutierrez OI, Lennon AM. et al Guidelines on management of pancreatic cysts detected in high-risk individuals: An evaluation of the 2017 Fukuoka guidelines and the 2020 International Cancer of the Pancreas Screening (CAPS) consortium statements. Pancreatology 2021; 21: 613-621 DOI: 10.1016/j.pan.2021.01.017. . Epub 2021 Feb 2. PMID: 33593706
- 11 GBD 2017 Pancreatic Cancer Collaborators. The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2019; 4: 934-947 DOI: 10.1016/S2468-1253(19)30347-4. . Epub 2019 Oct 21. Erratum in: Lancet Gastroenterol Hepatol. 2020; 5:e2. PMID: 31648972; PMCID: PMC7026711
- 12 Scherübl H. Tobacco Smoking and Gastrointestinal Cancer Risk. Visc Med 2022; 38: 217-222 DOI: 10.1159/000523668. . Epub 2022 Mar 17. PMID: 35814979; PMCID: PMC9209969
- 13 Molina-Montes E, Van Hoogstraten L, Gomez-Rubio P. et al. Pancreatic Cancer Risk in Relation to Lifetime Smoking Patterns, Tobacco Type, and Dose-Response Relationships. Cancer Epidemiol Biomarkers Prev 2020; 29: 1009-1018
- 14 Kuntz B, Starker A. Tabak – Zahlen und Fakten zum Konsum. In: Deutsche Hauptstelle für Suchtfragen (Hrsg). DHS Jahrbuch Sucht. Lengerich: Pabst Science Publishers; 2022
- 15 https://nordicwelfare.org/%20wp-content/uploads/2018/03/eng-180307_%20lankar.pdf
- 16 Yoo JE, Shin DW, Han K. et al Association of the Frequency and Quantity of Alcohol Consumption With Gastrointestinal Cancer. JAMA Netw Open 2021; 4: e2120382 DOI: 10.1001/jamanetworkopen.2021.20382. . Erratum in: JAMA Netw Open. 2021; 4:e2130551. PMID: 34406403; PMCID: PMC8374610
- 17 Scherübl H. Alcohol Use and Gastrointestinal Cancer Risk. Visc Med 2020; 36: 175-181 DOI: 10.1159/000507232. . Epub 2020 Apr 21. PMID: 32775347; PMCID: PMC7383256
- 18 World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Body fatness and weight gain and the risk of cancer. Online verfügbar unter www.dietandcancerreport.org
- 19 Rustgi VK, Li Y, Gupta K. et al. Bariatric Surgery Reduces Cancer Risk in Adults With Nonalcoholic Fatty Liver Disease and Severe Obesity. Gastroenterology 2021; S0016-5085(21)00529-1
- 20 Sjöholm K, Carlsson LMS, Svensson PA. et al Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-Term Results From the Swedish Obese Subjects Study. Diabetes Care 2021; 19: dc211335 DOI: 10.2337/dc21-1335. . Epub ahead of print. PMID: 34799430
- 21 López-Jiménez T, Duarte-Salles T, Plana-Ripoll O. et al Association between metabolic syndrome and 13 types of cancer in Catalonia: A matched case-control study. PLoS One 2022; 17: e0264634 DOI: 10.1371/journal.pone.0264634. . PMID: 35245317; PMCID: PMC8896701
- 22 Park JH, Han K, Hong JY. et al Changes in Metabolic Syndrome Status are Associated With Altered Risk of Pancreatic Cancer: A Nationwide Cohort Study. Gastroenterology 2022; 162: 509-520.e7 DOI: 10.1053/j.gastro.2021.09.070. . Epub 2021 Oct 13. PMID: 34653420
- 23 Khadka R, Tian W, Hao X. et al Risk factor, early diagnosis and overall survival on outcome of association between pancreatic cancer and diabetes mellitus: Changes and advances, a review. Int J Surg 2018; 52: 342-346 DOI: 10.1016/j.ijsu.2018.02.058. . Epub 2018 Mar 10. PMID: 29535016
- 24 Ose DJ, Viskochil R, Holowatyj AN. et al. Understanding the Prevalence of Prediabetes and Diabetes in Patients With Cancer in Clinical Practice: A Real-World Cohort Study. J Natl Compr Canc Netw 2021; 19: 709-718 DOI: 10.6004/jnccn.2020.7653.
- 25 Pang W, Yao W, Dai X. et al Pancreatic cancer-derived exosomal microRNA-19a induces β-cell dysfunction by targeting ADCY1 and EPAC2. Int J Biol Sci 2021; 17: 3622-3633 DOI: 10.7150/ijbs.56271. . PMID: 34512170; PMCID: PMC8416731
- 26 Su J, Pang W, Zhang A. et al Exosomal miR-19a decreases insulin production by targeting Neurod1 in pancreatic cancer associated diabetes. Mol Biol Rep 2022; 49: 1711-1720 DOI: 10.1007/s11033-021-06980-z. . Epub 2021 Dec 1. PMID: 34854011
- 27 Yuan C, Babic A, Khalaf N. et al. Diabetes, Weight Change, and Pancreatic Cancer Risk. JAMA Oncol 2020; 6 (10) e202948
- 28 Sharma A, Smyrk TC, Levy MJ. et al Fasting Blood Glucose Levels Provide Estimate of Duration and Progression of Pancreatic Cancer Before Diagnosis. Gastroenterology 2018; 155: 490-500.e2 DOI: 10.1053/j.gastro.2018.04.025. . Epub 2018 Apr 30. PMID: 29723506; PMCID: PMC6067966
- 29 Chari ST, Maitra A, Matrisian LM. et al Early Detection Initiative Consortium. Early Detection Initiative: A randomized controlled trial of algorithm-based screening in patients with new onset hyperglycemia and diabetes for early detection of pancreatic ductal adenocarcinoma. Contemp Clin Trials 2022; 113: 106659 DOI: 10.1016/j.cct.2021.106659. . Epub 2021 Dec 23. PMID: 34954100; PMCID: PMC8844106
- 30 Shah I, Wadhwa V, Bilal M. et al Pancreas Cancer Screening Study Group. Prospective Assessment for Prediabetes and New-Onset Diabetes in High-Risk Individuals Undergoing Pancreatic Cancer Screening. Gastroenterology 2021; 161: 1689-1691.e1 DOI: 10.1053/j.gastro.2021.06.055. . Epub 2021 Jun 24. PMID: 34175285
- 31 Chari ST, Andersen DK. Metabolic Surveillance for Those at High Risk for Developing Pancreatic Cancer. Gastroenterology 2021; 161: 1379-1380 DOI: 10.1053/j.gastro.2021.07.006. . Epub 2021 Jul 10. PMID: 34256058
- 32 Boursi B, Patalon T, Webb M. et al Validation of the Enriching New-Onset Diabetes for Pancreatic Cancer Model: A Retrospective Cohort Study Using Real-World Data. Pancreas 2022; 51: 196-199 DOI: 10.1097/MPA.0000000000002000. . PMID: 35404897
- 33 Sharma S, Tapper WJ, Collins A. et al Predicting Pancreatic Cancer in the UK Biobank Cohort Using Polygenic Risk Scores and Diabetes Mellitus. Gastroenterology 2022; 162: 1665-1674.e2 DOI: 10.1053/j.gastro.2022.01.016. . Epub 2022 Jan 21. PMID: 35065983
- 34 Xu YF, Hannafon BN, Zhao YD. et al Plasma exosome miR-196a and miR-1246 are potential indicators of localized pancreatic cancer. Oncotarget 2017; 8: 77028-77040 DOI: 10.18632/oncotarget.20332. . PMID: 29100367; PMCID: PMC5652761
- 35 Li J, Li Y, Chen S. et al Highly Sensitive Exosome Detection for Early Diagnosis of Pancreatic Cancer Using Immunoassay Based on Hierarchical Surface-Enhanced Raman Scattering Substrate. Small Methods 2022; 6: e2200154 DOI: 10.1002/smtd.202200154. . Epub 2022 Apr 23. PMID: 35460217
- 36 Channon LM, Tyma VM, Xu Z. et al Small extracellular vesicles (exosomes) and their cargo in pancreatic cancer: Key roles in the hallmarks of cancer. Biochim Biophys Acta Rev Cancer 2022; 1877 (03) 188728 DOI: 10.1016/j.bbcan.2022.188728. . Epub 2022 Apr 3. PMID: 35385773
- 37 Hong L, Xu L, Jin L. et al Exosomal circular RNA hsa_circ_0006220, and hsa_circ_0001666 as biomarkers in the diagnosis of pancreatic cancer. J Clin Lab Anal 2022; 36: e24447 DOI: 10.1002/jcla.24447. . Epub 2022 Apr 21. PMID: 35446993; PMCID: PMC9169197
- 38 Chen J, Yao D, Chen W. et al Serum exosomal miR-451a acts as a candidate marker for pancreatic cancer. Int J Biol Markers 2022; 37: 74-80 DOI: 10.1177/17246008211070018. . Epub 2022 Jan 10. Erratum in: Int J Biol Markers. 2022 Mar 14;:3936155221086337. PMID: 35001683
- 39 Nam H, Hong SS, Jung KH. et al A Serum Marker for Early Pancreatic Cancer With a Possible Link to Diabetes. J Natl Cancer Inst 2022; 114: 228-234 DOI: 10.1093/jnci/djab191. . PMID: 34613397; PMCID: PMC8826585
- 40 Hinestrosa JP, Kurzrock R, Lewis JM. et al Early-stage multi-cancer detection using an extracellular vesicle protein-based blood test. Commun Med (Lond) 2022; 2: 29 DOI: 10.1038/s43856-022-00088-6. . PMID: 35603292; PMCID: PMC9053211
- 41 Kartal E, Schmidt TSB, Molina-Montes E. et al. A faecal microbiota signature with high specificity for pancreatic cancer. Gut 2022; DOI: 10.1136/gutjnl-2021-324755.
- 42 Nagata N, Nishijima S, Kojima Y. et al Metagenomic Identification of Microbial Signatures Predicting Pancreatic Cancer From a Multinational Study. Gastroenterology 2022; 163: 222-238 DOI: 10.1053/j.gastro.2022.03.054. . Epub 2022 Apr 8. PMID: 35398347
- 43 Chen PT, Wu T, Wang P. et al Pancreatic Cancer Detection on CT Scans with Deep Learning: A Nationwide Population-based Study. Radiology 2022; 220152 DOI: 10.1148/radiol.220152. . Epub ahead of print. PMID: 36098642.
- 44 Mukherjee S, Patra A, Khasawneh H. et al Radiomics-based Machine-learning Models Can Detect Pancreatic Cancer on Prediagnostic Computed Tomography Scans at a Substantial Lead Time Before Clinical Diagnosis. Gastroenterology 2022; 163: 1435-1446.e3 DOI: 10.1053/j.gastro.2022.06.066. . Epub 2022 Jul 1. PMID: 35788343
- 45 Qureshi TA, Gaddam S, Wachsman AM. et al Predicting pancreatic ductal adenocarcinoma using artificial intelligence analysis of pre-diagnostic computed tomography images. Cancer Biomark 2022; 33: 211-217 DOI: 10.3233/CBM-210273. . PMID: 35213359; PMCID: PMC9255993