Luong Tiffany Q, Chen Qiaoling, Tran Tri M, Zhou Yichen, Lustigova Eva, Chen Wansu, Wu Bechien U
Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California.
Department of Internal Medicine, Southern California Permanente Medical Group, Los Angeles, California.
Gastro Hep Adv. 2022 Jul 21;1(6):1027-1036. doi: 10.1016/j.gastha.2022.07.009. eCollection 2022.
Identifying factors associated with increased short-term risk of pancreatic cancer in the setting of acute pancreatitis (AP) can inform clinical care decisions and expedite cancer diagnosis.
A retrospective cohort study of patients hospitalized for AP between 2007 and 2017 in an integrated health-care system in Southern California. AP cases were identified by diagnosis code with laboratory confirmation. Multivariable Cox proportional hazards regression model was used to assess risk of pancreatic cancer within 3 years of AP, adjusting for patient demographics, clinical parameters (body mass index, AP etiology, chronic pancreatitis, diabetes) and radiographic imaging features.
Among 9,490 patients hospitalized with AP, the mean (standard deviation) age was 55.8 (17.8) years, 55% were women, and 42% were Hispanic. Majority of AP cases were biliary (64%), 12% were alcohol-related, 5% were hypertriglyceridemia-induced, and 19% were other/unknown etiology. Ninety-five (1%) patients were diagnosed with pancreatic cancer within 3 years of AP (4.2 cases/1000 person-years). Risk factors for pancreatic cancer were age ≥65 years (hazard risk [HR]: 2.5, 95% confidence interval [CI]: 1.2-5.3), male sex (HR: 1.9, 95% CI: 1.2-2.8), Asian/Pacific Islander race (HR: 2.0, 95% CI: 1.1-3.6), and underweight body mass index (HR: 2.6, 95% CI: 1.1-6.5). In addition, other/unknown AP etiology (HR: 2.0, 95% CI: 1.3-3.1) and dilatation of the main pancreatic duct (HR: 6.6, 95% CI: 4.2-10.5) were independently associated with increased risk of pancreatic cancer.
In addition to older age, the lack of well-established etiology, underweight body habitus, and main pancreatic duct dilatation were independently associated with increased short-term risk of pancreatic cancer among patients hospitalized for AP.
确定与急性胰腺炎（AP）患者短期胰腺癌风险增加相关的因素，可为临床护理决策提供参考并加快癌症诊断。
对2007年至2017年在南加州一个综合医疗系统中因AP住院的患者进行回顾性队列研究。通过诊断代码并经实验室确认来识别AP病例。使用多变量Cox比例风险回归模型评估AP后3年内患胰腺癌的风险，并对患者人口统计学、临床参数（体重指数、AP病因、慢性胰腺炎、糖尿病）和影像学特征进行调整。
在9490例因AP住院的患者中，平均（标准差）年龄为55.8（17.8）岁，55%为女性，42%为西班牙裔。大多数AP病例为胆源性（64%），12%与酒精有关，5%由高甘油三酯血症引起，19%病因不明。95例（1%）患者在AP后3年内被诊断为胰腺癌（4.2例/1000人年）。胰腺癌的危险因素包括年龄≥65岁（风险比[HR]：2.5，95%置信区间[CI]：1.2 - 5.3）、男性（HR：1.9，95% CI：1.2 - 2.8）、亚洲/太平洋岛民种族（HR：2.0，95% CI：1.1 - 3.6）以及体重指数过低（HR：2.6，95% CI：1.1 - 6.5）。此外，其他/不明AP病因（HR：2.0，95% CI：1.3 - 3.1）和主胰管扩张（HR：6.6，95% CI：4.2 - 10.5）与胰腺癌风险增加独立相关。
除年龄较大外，病因不明、体重过轻和主胰管扩张与因AP住院患者的短期胰腺癌风险增加独立相关。
