Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026
A community-hospital collaborative diagnostic pathway for earlier detection of pancreatic cancer: Long-term impact of the Onomichi Method.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Hanada Keiji, Shimizu Akinori, Tanaka Shinji, Sasaki Nobutaka
Аннотация
BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies because opportunities for diagnosis at a curable stage are rarely realized. Population-wide screening is not recommended; therefore, scalable diagnostic strategies for earlier detection are required. We evaluated whether a structured community-hospital diagnostic pathway (the Onomichi Method) could advance diagnostic timing in routine clinical practice.
METHODS: This observational study analyzed a regional diagnostic pathway implemented in Japan since 2007. The pathway integrates risk assessment in primary care based on medical history, clinical risk factors, blood tests, and abdominal ultrasonography, followed by risk-based triage, tiered referral, endoscopic ultrasonography (EUS), and pancreatic juice cytology using endoscopic nasopancreatic drainage (ENPD). Temporal changes in diagnostic stage distribution and observed survival were evaluated through 2023.
RESULTS: Among 29,642 individuals assessed through risk-based primary-care evaluation between 2007 and 2023, 925 pancreatic cancers were diagnosed. The proportion of stage 0/I disease increased from 13.9% in 2007-2015 to 22.1% in 2016-2017 (chi-square test, p = 0.017). Observed 5-year survival improved from 14.9% to 20.7% across diagnostic eras (log-rank test, p = 0.040). Stage-stratified analyses showed no significant survival differences within stage 0/I (p = 0.533) or stage II-IV (p = 0.315) groups.
CONCLUSIONS: A community-hospital diagnostic pathway integrating primary care and advanced endoscopy was associated with a shift toward earlier pancreatic cancer diagnosis. Improved overall survival primarily reflected diagnostic stage migration rather than stage-specific therapeutic advances. These findings highlight the importance of structured community-hospital diagnostic pathways for improving the timeliness of pancreatic cancer diagnosis in routine clinical practice.
METHODS: This observational study analyzed a regional diagnostic pathway implemented in Japan since 2007. The pathway integrates risk assessment in primary care based on medical history, clinical risk factors, blood tests, and abdominal ultrasonography, followed by risk-based triage, tiered referral, endoscopic ultrasonography (EUS), and pancreatic juice cytology using endoscopic nasopancreatic drainage (ENPD). Temporal changes in diagnostic stage distribution and observed survival were evaluated through 2023.
RESULTS: Among 29,642 individuals assessed through risk-based primary-care evaluation between 2007 and 2023, 925 pancreatic cancers were diagnosed. The proportion of stage 0/I disease increased from 13.9% in 2007-2015 to 22.1% in 2016-2017 (chi-square test, p = 0.017). Observed 5-year survival improved from 14.9% to 20.7% across diagnostic eras (log-rank test, p = 0.040). Stage-stratified analyses showed no significant survival differences within stage 0/I (p = 0.533) or stage II-IV (p = 0.315) groups.
CONCLUSIONS: A community-hospital diagnostic pathway integrating primary care and advanced endoscopy was associated with a shift toward earlier pancreatic cancer diagnosis. Improved overall survival primarily reflected diagnostic stage migration rather than stage-specific therapeutic advances. These findings highlight the importance of structured community-hospital diagnostic pathways for improving the timeliness of pancreatic cancer diagnosis in routine clinical practice.