Risk of Cancer in Patients With Autoimmune Pancreatitis

Shiokawa, Masahiro; Kodama, Yuzo; Yoshimura, Kenichi; Kawanami, Chiharu; Mimura, Jun; Yamashita, Yoshihisa; Asada, Masanori; Kikuyama, Masataka; Okabe, Yoshihiro; Inokuma, Tetsuro; Ohana, Masaya; Kokuryu, Hiroyuki; Takeda, Kazuo; Tsuji, Yoshihisa; Minami, Ryuki; Sakuma, Yojiro; Kuriyama, Katsutoshi; Ota, Yuji; Tanabe, Wataru; Maruno, Takahisa; Kurita, Akira; Sawai, Yugo; Uza, Norimitsu; Watanabe, Tomohiro; Haga, Hironori; Chiba, Tsutomu

doi:10.1038/ajg.2012.465

Cited by 224 publications

(241 citation statements)

References 37 publications

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“…Concerning AIP and total malignancy, it is also difficult to draw any specific conclusions given our current understanding. In light of the results of two reports [14,16], however, it seems unlikely that AIP is responsible for the increased risk of total malignancy. Shiokawa et al…”

Section: Discussionmentioning

confidence: 86%

“…If 100 patients with AIP are necessary to identify one case of pancreatic cancer and the SIR is 3.6, as per our previous report [14], a sample of approximately 450 patients is necessary to demonstrate statistical significance [15]. It is possible that the SIR is much \ 3.6 [16]. Thus, large-scale nationwide research is required to resolve this problem.…”

Section: Aip and Pancreatobiliary Cancermentioning

confidence: 99%

“…They reported malignancy in 11 patients (10.4 %) with a SIR for total malignancy of 3.83, which was significantly high. Shiokawa et al [16] followed up 108 patients with AIP for a median of 3.3 years. They identified 18 malignancies in 15 patients (13.9 %), and reported a SIR of 2.7 (95 % CI 2.4-3.9), which was significantly high, comprising gastric cancer (n = 7), lung cancer (n = 3), malignant lymphoma (n = 2), prostate cancer (n = 2), colon cancer (n = 2), bile duct cancer (n = 1), and thyroid cancer (n = 1).…”

Section: Aip Igg4-rd and Total Malignanciesmentioning

confidence: 99%

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Association between autoimmune pancreatitis and malignancy

Hirano

Isayama

Tada

et al. 2014

Clin J Gastroenterol

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Chronic inflammatory diseases are often associated with malignancy, and this phenomenon occurs even in the field of gastroenterology. For example, chronic pancreatitis has been reported to be highly associated with the occurrence of pancreatic cancer. However, the association between autoimmune pancreatitis (AIP) and pancreatic cancer is still an unsolved problem. As AIP is associated with immunoglobulin G4-related disease, which causes a variety of inflammatory and fibrotic lesions, the association between AIP and total malignancies is also a matter of interest. Here, we discuss the association between AIP and malignancy. As for the association between AIP and pancreatic cancer, there is no conclusive evidence, although several reports have suggested that the relative risk of pancreatic cancer is high in AIP. Concerning the association between AIP and total malignancies, there are two reports from Japan. Neither report supported the idea that chronic inflammation in AIP caused the increased risk of total malignancies. However, one report proposed the possibility that AIP might develop as a paraneoplastic syndrome in some patients because many cancers occurred within 1 year of AIP diagnosis, and thereby concluded that patients with AIP were at high risk of having various cancers. The paraneoplastic syndrome hypothesis should be tested in future studies.

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Section: Discussionmentioning

confidence: 86%

Section: Aip and Pancreatobiliary Cancermentioning

confidence: 99%

Section: Aip Igg4-rd and Total Malignanciesmentioning

confidence: 99%

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Association between autoimmune pancreatitis and malignancy

Hirano

Isayama

Tada

et al. 2014

Clin J Gastroenterol

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“…Two recent studies evaluating the SIR support the association between IgG4-RD and total malignancies (16,17). Yamamoto et al reported the SIR for total malignancies to be 3.8 in their series, which consisted primarily of patients with Mikulicz's disease (16), while Shiokawa et al reported the SIR to be 2.7 in their series, which consisted of AIP patients only (17).…”

Section: Discussionmentioning

confidence: 98%

Incidence of Malignancies in Patients with IgG4-related Disease

et al. 2014

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Objective It has been discussed whether IgG4-related disease (IgG4-RD), including autoimmune pancreatitis (AIP), is associated with malignancy; however, the issue has not been clarified. Methods We analyzed 113 patients with IgG4-RD in whom malignancy was not diagnosed at the time of IgG4-RD onset and the follow-up period was longer than six months. A total of 95 patients had AIP. The mean follow-up period was 73 months. The incidence of the observed malignancies was compared with the expected incidence in an age-and sex-matched general Japanese population based on the Vital Statistics of Japan. Results There were 15 malignancies (lung cancer in five patients, pancreatic cancer in two patients, gastric cancer in two patients, bile duct cancer in one patient, renal cancer in one patient, breast cancer in one patient, tongue cancer in one patient, malignant melanoma in one patient and acute myeloid leukemia in one patient) in 14 patients during the follow-up period. The calculated standardized incidence rate of the total malignancies was not significant, that is, 1.04 (95% CI 0.57-1.75). Conclusion The incidence of total malignancies in IgG4-RD patients is similar to that observed in the general population. At present, it is reasonable to conclude that IgG4-RD is not associated with an increased incidence of total malignancies.

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“…However, there is very limited data on the incidence of malignancy in AIP. Shiokawa et al [46] reported that patients with AIP are at high risk of having various cancers. e highest risk for cancer in the rst year a er AIP diagnosis and absence of AIP relapse a er successful treatment of the coexisting cancers suggest that AIP may develop as a paraneoplastic syndrome in some patients.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

Chatterjee

Oppong

Scott

et al. 2014

JGLD

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Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

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Risk of Cancer in Patients With Autoimmune Pancreatitis

Abstract: Patients with AIP are at high risk of having various cancers. The highest risk for cancer in the first year after AIP diagnosis and absence of AIP relapse after successful treatment of the coexisting cancers suggest that AIP may develop as a paraneoplastic syndrome in some patients.

Cited by 224 publications

References 37 publications

Association between autoimmune pancreatitis and malignancy

Association between autoimmune pancreatitis and malignancy

Incidence of Malignancies in Patients with IgG4-related Disease

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

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