Abstract：
Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year overall survival rate of 10%. In November 2018, NCCN recommended that all patients with PDAC receive genetic counseling (GC) and germline testing regardless of family history. We hypothesized that patients with PDAC were more likely to be referred for testing after this change to the guidelines, regardless of presumed predictive factors, and that compliance would be further improved following the implementation of a hereditary cancer clinic (HCC).
We conducted a single-institution retrospective analysis of patients diagnosed with PDAC from June 2017 through December 2021 at University of California, Irvine. We compared rates of genetics referral among patients in different diagnostic eras: the 18-month period before the NCCN Guideline change (pre-NCCN era: June 2017 through November 2018), 14 months following the change (post-NCCN era: December 2018 through January 2020), and 18 months after the creation of an HCC (HCC era: June 2020 through December 2021). Family and personal cancer history, genetics referral patterns, and results of GC were recorded. Data were compared using chi-square, Fisher exact, and multivariate analyses.
A total of 335 patients were treated for PDAC (123 pre-NCCN, 109 post-NCCN, and 103 HCC) at University of California, Irvine. Demographics across groups were comparable. Prior to the guideline changes, 30% were referred to GC compared with 54.7% in the post-NCCN era. After the implementation of the HCC, 77.4% were referred to GC (P<.0001). The odds ratio (OR) for referral to GC among patients with a positive family history of cancer progressively decreased following the change (pre-NCCN era: OR, 11.90 [95% CI, 3.00-80.14]; post-NCCN era: OR, 3.39 [95% CI, 1.13-10.76]; HCC era: OR, 3.11 [95% CI, 0.95-10.16]).
The 2018 updates to the NCCN Guidelines for PDAC recommending germline testing for all patients with PDAC significantly increased GC referral rates at our academic medical center. Implementation of an HCC further boosted compliance with guidelines.
We conducted a single-institution retrospective analysis of patients diagnosed with PDAC from June 2017 through December 2021 at University of California, Irvine. We compared rates of genetics referral among patients in different diagnostic eras: the 18-month period before the NCCN Guideline change (pre-NCCN era: June 2017 through November 2018), 14 months following the change (post-NCCN era: December 2018 through January 2020), and 18 months after the creation of an HCC (HCC era: June 2020 through December 2021). Family and personal cancer history, genetics referral patterns, and results of GC were recorded. Data were compared using chi-square, Fisher exact, and multivariate analyses.
A total of 335 patients were treated for PDAC (123 pre-NCCN, 109 post-NCCN, and 103 HCC) at University of California, Irvine. Demographics across groups were comparable. Prior to the guideline changes, 30% were referred to GC compared with 54.7% in the post-NCCN era. After the implementation of the HCC, 77.4% were referred to GC (P<.0001). The odds ratio (OR) for referral to GC among patients with a positive family history of cancer progressively decreased following the change (pre-NCCN era: OR, 11.90 [95% CI, 3.00-80.14]; post-NCCN era: OR, 3.39 [95% CI, 1.13-10.76]; HCC era: OR, 3.11 [95% CI, 0.95-10.16]).
The 2018 updates to the NCCN Guidelines for PDAC recommending germline testing for all patients with PDAC significantly increased GC referral rates at our academic medical center. Implementation of an HCC further boosted compliance with guidelines.
摘要：
背景：胰腺导管腺癌（PDAC）预后不良，5年总生存率为10%。2018年11月，NCCN建议所有PDAC患者接受遗传咨询（GC）和种系测试，无论家族史如何。我们假设PDAC患者在指南更改后更有可能被转诊进行检测。不管假定的预测因素，在实施遗传性癌症诊所（HCC）后，依从性将得到进一步改善。
方法：我们对2017年6月至2021年12月在加州大学诊断为PDAC的患者进行了单机构回顾性分析。Irvine.我们比较了不同诊断时代患者的遗传学转诊率：NCCN指南变更前18个月（NCCN前时代：2017年6月至2018年11月），变化后14个月（后NCCN时代：2018年12月至2020年1月），在HCC创建18个月后(HCC时代：2020年6月至2021年12月)。家族和个人癌症史，遗传学转诊模式,并记录GC的结果。使用卡方比较数据，费希尔确切,和多变量分析。
结果：共有335例患者接受了PDAC治疗（123个pre-NCCN，109后NCCN，和103HCC）在加州大学，Irvine.各组人口统计学具有可比性。在准则变更之前，与NCCN后时代的54.7%相比，30%的人被提到GC。HCC实施后，77.4%参考GC(P<0.0001)。在具有癌症家族史阳性的患者中，转诊至GC的比值比（OR）随着变化而逐渐降低（NCCN时代之前：OR，11.90[95%CI，3.00-80.14]；后NCCN时代：或，3.39[95%CI，1.13-10.76]；肝癌时代：OR，3.11[95%CI，0.95-10.16]）。
结论：2018年对PDAC的NCCN指南进行了更新，建议对所有PDAC患者进行种系检测，显着提高了我们学术医疗中心的GC转诊率。HCC的实施进一步提高了对指南的依从性。
方法：我们对2017年6月至2021年12月在加州大学诊断为PDAC的患者进行了单机构回顾性分析。Irvine.我们比较了不同诊断时代患者的遗传学转诊率：NCCN指南变更前18个月（NCCN前时代：2017年6月至2018年11月），变化后14个月（后NCCN时代：2018年12月至2020年1月），在HCC创建18个月后(HCC时代：2020年6月至2021年12月)。家族和个人癌症史，遗传学转诊模式,并记录GC的结果。使用卡方比较数据，费希尔确切,和多变量分析。
结果：共有335例患者接受了PDAC治疗（123个pre-NCCN，109后NCCN，和103HCC）在加州大学，Irvine.各组人口统计学具有可比性。在准则变更之前，与NCCN后时代的54.7%相比，30%的人被提到GC。HCC实施后，77.4%参考GC(P<0.0001)。在具有癌症家族史阳性的患者中，转诊至GC的比值比（OR）随着变化而逐渐降低（NCCN时代之前：OR，11.90[95%CI，3.00-80.14]；后NCCN时代：或，3.39[95%CI，1.13-10.76]；肝癌时代：OR，3.11[95%CI，0.95-10.16]）。
结论：2018年对PDAC的NCCN指南进行了更新，建议对所有PDAC患者进行种系检测，显着提高了我们学术医疗中心的GC转诊率。HCC的实施进一步提高了对指南的依从性。
