Improving Diagnosis of PDAC in Asymptomatic Patients Can Improve Overall Survival

Javed AA, Habib JR, Fishman EK, et al. Incidental Diagnosis of Pancreatic Cancer and Association with Improved Patient Outcomes: Assessing the Potential Clinical Utility of Liquid Biopsy Based Screening Tests. J Am Coll Surg. December 2025.

Authors of this study aimed to evaluate the association between incidental diagnosis on outcomes in pancreatic ductal adenocarcinoma (PDAC) and assess the potential role of liquid biopsies.

An institutional registry was used to identify patients undergoing resection for PDAC between 2010 and 2015. Patients were stratified based on presenting symptoms, and outcomes were analyzed. Preoperatively collected plasma that was available on these patients was analyzed using a multianalyte screening test based on circulating tumor DNA and proteins.

79 (9.6%) of 823 patients were diagnosed incidentally (asymptomatic at diagnosis). Incidental diagnosis was associated with type of surgery and absence of nodal disease and lymphovascular invasion (all p <0.05). On multivariable analysis, incidental diagnosis (HR, 0.561; 95%CI, 0.406-0.775; p <0.001) was independently associated with improved overall survival (OS), while tumor size ≥4 cm (HR, 1.617; 95% CI, 1.201-2.176; p = 0.002), nodal disease (HR, 1.259; 95% CI, 1.018–1.558; p = 0.034), perineural invasion (HR, 1.338; 95% CI, 1.030–1.739; p = 0.029), and positive margins (HR, 1.302; 95% CI, 1.058–1.602; p = 0.013) were associated with poorer OS. 

Asymptomatic patients had a significantly longer OS (median-OS: 38 versus 19 months (p <0.001). The rate of multianalyte test positivity was 75% (6/8) in asymptomatic patients compared to 73% (59/81) in symptomatic patients (p = 0.895).

With 10% of patients with PDAC are diagnosed incidentally, and incidental diagnosis being independently associated with improved OS, these findings further reinforce the need for development of screening tools that can increase the rate of diagnosis at an asymptomatic stage and improve survival.