Lesmana Cosmas R A, Gani Rino A, Lesmana Laurentius A
Digestive Disease and GI Oncology Center Medistra Hospital Jakarta Indonesia.
Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital Universitas Indonesia Jakarta Indonesia.
JGH Open. 2017 Dec 23;2(1):4-7. doi: 10.1002/jgh3.12032. eCollection 2018 Feb.
Non-alcoholic fatty pancreas disease (NAFPD) is a disease that ranges from simple steatosis and can further lead to chronic pancreatitis and possible pancreatic cancer development. Its exact pathogenesis and impact on clinical practice are still largely unknown. Pancreatic cancer is still the most lethal malignancy in the world. Studies about the relationship between NAFPD and pancreatic cancer are still lacking. This study aims to find the possible role of endoscopic ultrasound (EUS) examination as a screening tool in NAFPD patients based on EUS examination among pancreatic cancer patients.
EUS hospital data were collected within a 2-year period, and all patients who underwent EUS procedures were analyzed. Pancreatic malignancy was diagnosed based on imaging and tumor markers and cytopathology using the endoscopic ultrasound fine needle aspiration (EUS-FNA) procedure. Patients with pre-existing pancreatic diseases, significant alcohol consumption, or other primary cancer with metastasis to the pancreas were excluded. Statistical analysis was performed using SPSS version 23.0.
In total, 162 patients (75 females and 87 males) were recruited for database analysis.^ Pancreatic malignancy was found in 43 (26.5%) patients, whereas fatty pancreas was found in 53 (32.7%) patients, and this was commonly found among pancreatic cancer patients.^ Based on logistic regression analysis, factors such as age, gender, diabetes, and chronic pancreatitis were not found to be significant risk factors for pancreatic malignancy where fatty pancreas is the only significant risk factor for pancreatic cancer (odds ratio: 18.027 [95% CI: 7.288-44.588]).
Prevalence of NAFPD among pancreatic cancer patients is high. Future studies can be conducted to show whether EUS can be considered a screening tool for the early detection of pancreatic malignancy in NAFPD patients; a cohort prospective study might also be needed to show clear causality between fatty pancreas and pancreatic cancer.
非酒精性脂肪性胰腺疾病（NAFPD）是一种从单纯脂肪变性开始的疾病，可进一步发展为慢性胰腺炎，并可能引发胰腺癌。其确切发病机制及其对临床实践的影响在很大程度上仍不清楚。胰腺癌仍然是世界上最致命的恶性肿瘤。关于NAFPD与胰腺癌之间关系的研究仍然缺乏。本研究旨在基于胰腺癌患者的内镜超声（EUS）检查，探讨EUS检查作为NAFPD患者筛查工具的可能作用。
收集2年内的EUS医院数据，并对所有接受EUS检查的患者进行分析。根据影像学、肿瘤标志物以及使用内镜超声细针穿刺（EUS-FNA）程序进行的细胞病理学诊断胰腺恶性肿瘤。排除既往有胰腺疾病、大量饮酒或其他原发性癌症转移至胰腺的患者。使用SPSS 23.0进行统计分析。
总共招募了162例患者（75例女性和87例男性）进行数据库分析。43例（26.5%）患者被发现患有胰腺恶性肿瘤，53例（32.7%）患者被发现有胰腺脂肪变性，且这在胰腺癌患者中较为常见。基于逻辑回归分析，年龄、性别、糖尿病和慢性胰腺炎等因素未被发现是胰腺恶性肿瘤的显著危险因素，而胰腺脂肪变性是胰腺癌的唯一显著危险因素（比值比：18.027 [95%置信区间：7.288 - 44.588]）。
胰腺癌患者中NAFPD的患病率较高。未来的研究可以探讨EUS是否可被视为NAFPD患者早期检测胰腺恶性肿瘤的筛查工具；可能还需要进行队列前瞻性研究以明确胰腺脂肪变性与胰腺癌之间的因果关系。
