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Incidence and Risk of Pancreatic Cancer in Patients with a New Diagnosis of Chronic Pancreatitis

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Abstract

Background

Chronic pancreatitis (CP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC); nevertheless, the true incidence of PDAC in CP patients in the United States remains unclear.

Aims

We evaluated the risk of developing PDAC two or more years after a new diagnosis of CP.

Methods

Retrospective study of veterans from September 1999 to October 2015. A three-year washout period was applied to exclude patients with preexisting CP and PDAC. PDAC risk was evaluated in patients with new-diagnosis CP and compared with controls without CP using Cox-proportional hazards model. CP, PDAC, and other covariates were extracted using ICD-9 codes.

Results

After exclusions, we identified 7,883,893 patients [new-diagnosis CP − 21,765 (0.28%)]. PDAC was diagnosed in 226 (1.04%) patients in the CP group and 15,858 (0.20%) patients in the control group (p < 0.001). CP patients had a significantly higher PDAC risk compared to controls > 2 years [adjusted hazard ratio (HR) 4.28, 95% confidence interval (CI) 3.74–4.89, p < 0.001], 5 years (adjusted HR 3.32, 95% CI 2.75–4.00, p < 0.001) and 10 years of follow-up (adjusted HR 3.14, 95% CI 1.99–4.93, p < 0.001), respectively. By multivariable analysis, age (odds ratio 1.02, 95% CI 1.00–1.03, p = 0.03), current smoker (odds ratio 1.67, 95% CI 1.02–2.74, p = 0.042), current smoker + alcoholic (odds ratio 2.29, 95% CI 1.41–3.52, p < 0.001), and diabetes (odds ratio 1.51, 95% CI 1.14–1.99, p = 0.004) were the independent risk factors for PDAC.

Conclusion

Our data show that after controlling for etiology of CP and other cofactors, the risk of PDAC increased in CP patients after two years of follow-up, and risk was consistent and sustained beyond 5 years and 10 years of follow-up.

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Acknowledgment

This material is the result of work supported with resources and the use of facilities at the VA Saint Louis Health Care System. The contents do not represent the views of the U.S. Department of Veterans Affairs or the Untied Stated Government.

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Authors and Affiliations

  1. Saint Louis University Center for Outcomes Research (SLUCOR), 3545 Lafayette Ave, Salus Center 4th Floor, SLUCOR Office, St. Louis, MO, 63104, USA

    Satish Munigala, Divya S. Subramaniam & Thomas E. Burroughs

  2. School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, USA

    Dipti P. Subramaniam

  3. Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Darwin L. Conwell

  4. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Sunil G. Sheth

Authors
  1. Satish Munigala
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  2. Divya S. Subramaniam
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  3. Dipti P. Subramaniam
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  4. Thomas E. Burroughs
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  5. Darwin L. Conwell
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  6. Sunil G. Sheth
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Contributions

SM contributed to study concept and design, statistical analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and approved the final draft of the manuscript. DSS was involved in critical revision of the manuscript for important intellectual content and approved the final draft of the manuscript. DPS was involved in critical revision of the manuscript for important intellectual content and approved the final draft of the manuscript. TEB was involved in critical revision of the manuscript for important intellectual content and approved the final draft of the manuscript. DLC was involved in critical revision of the manuscript for important intellectual content and approved the final draft of the manuscript. SS contributed to study concept and design, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and approved the final draft of the manuscript.

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Correspondence to Satish Munigala.

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Supplementary Information

10620_2021_6886_MOESM1_ESM.tiff

Supplementary Figure 1. Pancreatic cancer cases diagnosed among chronic pancreatitis patients, by year of follow-up (TIFF 943 kb)

Supplementary Figure 2. Cumulative incidence of pancreatic cancer by chronic pancreatitis etiology (PNG 43 kb)

10620_2021_6886_MOESM3_ESM.docx

Supplemental Table 1. Predictors of pancreatic cancer among chronic pancreatitis patients (after 2 years of follow-up) (DOCX 15 kb)

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Munigala, S., Subramaniam, D.S., Subramaniam, D.P. et al. Incidence and Risk of Pancreatic Cancer in Patients with a New Diagnosis of Chronic Pancreatitis. Dig Dis Sci 67, 708–715 (2022). https://doi.org/10.1007/s10620-021-06886-7

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  • DOI: https://doi.org/10.1007/s10620-021-06886-7

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