Association between chronic pancreatitis and pancreatic cancer: A 10‐year retrospective study of endoscopically treated and surgical patients

Abstract

Pancreatic cancer (PC) has a poor prognosis. Chronic pancreatitis (CP) associates with high morbidity and mortality, and serves as a risk factor for PC. Our study aimed to assess the association between endoscopically treated CP patients and PC, and to establish the rate of CP among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). We retrospectively analyzed 458 CP patients undergoing endoscopic treatment (ET) between 2000 and 2010 and 349 PDAC patients undergoing pancreatic resection between 2000 and 2014 at the Helsinki University Hospital. The likelihood of diagnosing PC was highest within 2 years of a CP diagnosis: 21 of 30 PC diagnoses occurred during this time. After 2 years follow-up: 9 of 30 PC diagnoses occurred 2-12 years from CP diagnosis. Two patients were diagnosed with CP before PDAC. Multivariate analysis showed two prognostic factors indicative of PC development: biliary stricture (HR 9.21; 95% CI 3.76-22.08) and a higher age (per 5-year increases) at CP onset (HR 1.55; 95% CI 1.30-1.85). Among 458 CP patients, the median overall survival without PC was 14.7 years (95% CI 12.0-17.3), falling to 1.6 years (95% CI 1.2-2.0) with PC. The high incidence of PC among CP patients at the beginning of follow-up likely reflected an initially missed PC diagnoses. In long-term follow-up, an increasing PC incidence might reflect the PC-predisposing impact of CP. Thus, we recommend careful follow-up for patients presenting with a recently diagnosed CP and risk factors for PC. biliary stricture. 2 Pancreatic ductal adenocarcinoma (PDAC) is the most common pancreatic neoplasm with a tendency to spread silently: even in patients suitable for radical resection, its recurrence rate reaches up to 80%. 3 Currently, no screening tools exist to detect pancreatic cancer (PC) at an early stage. The incidence of PC in Europe is 7.7/100,000, with an average lifelong risk for PC of approximately 1%. 4,5 Known risk factors for PC include diabetes mellitus (DM), obesity, alcohol consumption, cigarette smoking and a history of acute or chronic pancreatitis. 6,7 Previous studies suggested that CP markedly increases the risk of PC, varying from 2.2-to 26.7-fold. 8-11 The cancer risk also varies between CP etiologies: patients with inherited CP might have a higher risk compared to other etiologies. 2,12 However, the prevalence and incidence of PC among CP patients undergoing ET remain unclear. A retrospective cohort study by Munigala et al. 13 determined that approximately 5% of patients with PC are initially misdiagnosed with CP. One diagnostic challenge in CP patients undergoing ET involves detecting malignant pancreatic duct (PD) changes. In addition, no consensus guidelines on PC screening among patients with CP exist. Thus, our primary objective was to determine the prevalence of CP among patients operated on for PDAC and to determine the incidence of PC among CP patients H.S. and L.K. shared equally to the last authorship.

Temporality of clinical factors associated with pancreatic cancer: a case-control study using linked electronic health records

“…It is hypothesised that progression to PC from precancerous non-invasive lesions may take 17 months to 10 years [ 10 ], providing a potentially long window for early detection or possible prevention. In particular, well-established risk factors such as diabetes or chronic pancreatitis are first identified in PC patients during the 2 to 3 years window prior to PC diagnosis [ 6 , 9 , 11 ]. The long latency period of PC often follows with rapid deterioration within a space of few months [ 12 ], yet studies suggest the tumour remains resectable in asymptomatic patients as late as 6 months before the clinical diagnosis [ 13 , 14 ].…”

Incidence and risk of pancreatic cancer in patients with chronic pancreatitis: defining the optimal subgroup for surveillance

“…In our study, all imaging tests of the patients, as well as diagnostic codes, were reviewed to nd de nite CP. A few previous studies evaluated only patients who underwent surgery or endoscopic management for CP 3,9 . These patients had complicated CPs and were followed up well.…”

Pancreatitis and pancreatic cancer: A case of the chicken or the egg

“…Additionally, alcohol consumption and smoking, both well-known risk factors for PDAC, form important confounding factors as patients with CP often have a history of alcohol- and nicotine abuse[ 26 ]. Other risk factors are older age at disease onset, obesity, concurrent DM and pancreatic duct dilatation[ 27 , 28 ].…”