Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St Louis, Missouri, USA.
1] Veterans Affairs St Louis Health Care System, St Louis, Missouri, USA [2] Department of Biostatistics, Saint Louis University School of Public Health, St Louis, Missouri, USA.
Am J Gastroenterol. 2014 Nov;109(11):1824-30. doi: 10.1038/ajg.2014.318. Epub 2014 Oct 7.
Patients with pancreatic cancer (PaCa) sometimes present with symptoms suggestive of chronic pancreatitis (CP). We evaluated the prevalence of undiagnosed PaCa in patients with new CP diagnosis.
This is a retrospective study with data from Veterans Health Administration national medical care data sets from fiscal year 1998-2007. A 3-year washout period was used to identify patients with preexisting PaCa and preexisting CP diagnosis.
Among 471,992 veterans included, 917 (0.19%) had PaCa, 2,557 (0.54%) had a preexisting CP, and 2,175 (0.46%) had a new diagnosis of CP. PaCa was diagnosed ≤2 years following CP diagnosis in 44 patients, comprising 4.80% of patients with PaCa. Following a new diagnosis of CP, the risk of PaCa diagnosis was most marked in the first year (incidence 18.04 per 1,000 person-years (py), relative risk (RR) 63.43) and became similar to risk in patients with preexisting CP in the third year. The first-year incidence of PaCa was 7.33/1,000 py in the fifth decade and reached 36.91/1,000 py after seventh decade of life. Time to PaCa diagnosis following a CP diagnosis was ≤60 days in 14 patients, 3-12 months in 25 patients, and 13-24 months in 5 patients.
Approximately 5% of patients with PaCa are initially misdiagnosed as CP, and in two-thirds of these patients the cancer diagnosis is delayed by >2 months. PaCa should reliably be excluded before making a new CP diagnosis in patients who are >40 years old, especially in those without heavy smoking or alcohol history.
胰腺癌（PaCa）患者有时会出现类似于慢性胰腺炎（CP）的症状。我们评估了新诊断为 CP 的患者中未确诊的 PaCa 的患病率。
这是一项回顾性研究，数据来自退伍军人健康管理局 1998 年至 2007 年的国家医疗保健数据集。使用 3 年洗脱期来识别患有既往 PaCa 和既往 CP 诊断的患者。
在纳入的 471992 名退伍军人中，有 917 人（0.19%）患有 PaCa，2557 人（0.54%）患有既往 CP，2175 人（0.46%）新诊断为 CP。在 CP 诊断后 ≤2 年内诊断出 44 例 PaCa，占 PaCa 患者的 4.80%。新诊断为 CP 后，PaCa 诊断的风险在第一年最为显著（发病率为每 1000 人年 18.04 例，相对风险（RR）为 63.43），并在第三年与既往 CP 患者的风险相似。在第五个十年，PaCa 的第一年发病率为每 1000 人年 7.33 例，在第七个十年后达到每 1000 人年 36.91 例。在 14 例患者中，CP 诊断后 PaCa 的诊断时间为 ≤60 天，在 25 例患者中为 3-12 个月，在 5 例患者中为 13-24 个月。
约 5%的 PaCa 患者最初被误诊为 CP，其中三分之二的患者癌症诊断延迟 >2 个月。对于年龄 >40 岁的新诊断为 CP 的患者，特别是那些没有大量吸烟或饮酒史的患者，在做出新的 CP 诊断之前，应可靠地排除 PaCa。
