Identification of Individuals at Increased Risk for Pancreatic Cancer in a Community-Based Cohort of Patients With Suspected Chronic Pancreatitis

Abstract

OBJECTIVES: We lack reliable methods for identifying patients with chronic pancreatitis (CP) at increased risk for pancreatic cancer. We aimed to identify radiographic parameters associated with pancreatic cancer in this population. METHODS: We conducted a retrospective cohort study of patients with suspected CP within an integrated healthcare system in Southern California in 2006–2015. Patients were identified by a diagnostic code and confirmed by imaging findings (parenchymal calcification, ductal stones, glandular atrophy, pseudocyst, main duct dilatation, duct irregularity, abnormal side branch, or stricture) defined by the natural language processing of radiographic reports. We used Cox regression to determine the relationship of smoking, alcohol use, acute pancreatitis, diabetes, body mass index, and imaging features with the risk of incident pancreatic cancer at least 1 year after abnormal pancreas imaging. RESULTS: We identified 1,766 patients with a diagnostic code and an imaging feature for CP with a median follow-up of 4.5 years. There were 46 incident pancreatic cancer cases. Factors that predicted incident pancreatic cancer after 1-year of follow-up included obesity (hazard ratio 2.7, 95% confidence interval: 1.2–6.1) and duct dilatation (hazard ratio 10.5, 95% confidence limit: 4.0–27). Five-year incidence of pancreatic cancer in this population with duct dilatation was 6.3%. DISCUSSION: High incidence of pancreatic cancer in suspected patients with CP with pancreatic duct dilatation warrants regular surveillance for pancreatic cancer.

Chronic pancreatitis is a risk factor for pancreatic cancer and incidence increases with duration of disease: A systematic review and meta-analysis

“…The domains of the Newcastle-Ottawa Scale are listed for each study in Table 2 (21–45). The risk of bias in the included studies was low to moderate because of limitations in demonstration of outcome at the start of the study and adequate length of follow-up.…”

“…Six studies reported the CIRs of PDAC over time after the diagnosis of CP ( 21 , 22 , 24 , 25 , 29 , 30 ). Data were insufficient to conduct meta-regression because of the small number of studies, and data for covariates of interest were not consistently available.…”

“…We found 25 studies that met our inclusion criteria: 1 for AP and CP, 1 for AIP and CP, 3 for AIP, 4 for HP, and 16 for CP only. Table 1 summarizes the descriptive characteristics of the 17 cohort studies, 7 single-arm cohort studies, and 2 case-control studies (21–45). Midha et al (23) conducted both case-control and cohort studies and reported their findings in the same article (Midha a: Cohort study; Midha b: Case-control study).…”

Artificial Intelligence and Early Detection of Pancreatic Cancer

“…Of note, several studies show that the probability PDAC development can be further increased by including additional factors such as weight change, ethnicity, and lifestyle factors that are commonly contained in electronic medical records. [171][172][173][174][175][176][177][178] Other well-known high-risk populations must be considered in identifying patients who need screening with imaging and liquid biopsy approaches. For example, chronic pancreatitis especially those who develop diabetes with chronic pancreatitis have the highest proportional risk of developing PDAC.…”

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 ].…”