Division of Gastroenterology, Department of Medicine, University of Szeged, Pf.: 427, Szeged, H-6701, Hungary.
Department of Gastroenterology and Internal Medicine, Markusovszky Teaching Hospital, Szombathely, Hungary.
BMC Gastroenterol. 2024 Aug 21;24(1):278. doi: 10.1186/s12876-024-03367-9.
BACKGROUND/OBJECTIVES: Autoimmune pancreatitis (AIP) is a diagnosis-challenging disease that often mimics pancreatic malignancy. Pancreatic resection is considered to be a curative treatment for pancreatic ductal adenocarcinoma (PDAC). This meta-analysis aims to study the incidence of AIP in patients who have undergone pancreatic resection for clinical manifestation of cancer.
A comprehensive search was conducted in three databases, PubMed, Embase and the Cochrane Library, using the terms 'autoimmune pancreatitis' and 'pancreatic resection' and supplemented by manual checks of reference lists in all retrieved articles.
Ten articles were included in the final analysis. 8917 pancreatic resections were performed because of a clinical suspicion of pancreatic cancer. AIP accounted for 140 cases (1.6%). Type 1 AIP comprised the majority of cases, representing 94% (132 cases), while type 2 AIP made up the remaining 6% (eight cases) after further classification. AIP accounted for almost 26% of all cases of benign diseases involving unnecessary surgery and was overrepresented in males in 70% of cases compared to 30% in females. The mean age for AIP patients was 59 years. Serum CA 19 - 9 levels were elevated in 23 out of 47 (49%) AIP patients, where higher levels were detected more frequently in patients with type 1 AIP (51%, 22 out of 43) than in those with type 2 AIP (25%, 1 out of 4). The sensitivity of IgG4 levels in type 1 AIP was low (43%, 21/49 patients).
Even with modern diagnostic methods, distinguishing between AIP and PDAC can still be challenging, thus potentially resulting in unnecessary surgical procedures in some cases. Serum CA 19 - 9 levels are not useful in distinguishing between AIP and PDAC. Work must thus be done to improve diagnostic methods and avoid unnecessary complicated surgery.
背景/目的：自身免疫性胰腺炎（AIP）是一种具有挑战性的疾病，常与胰腺恶性肿瘤相混淆。胰腺切除术被认为是治疗胰腺导管腺癌（PDAC）的一种根治性治疗方法。本荟萃分析旨在研究因癌症临床表现而行胰腺切除术的患者中 AIP 的发生率。
在三个数据库 PubMed、Embase 和 Cochrane Library 中使用“自身免疫性胰腺炎”和“胰腺切除术”这两个术语进行全面检索，并对所有检索到的文章的参考文献进行手工检查以补充检索。
最终有 10 篇文章纳入了分析。8917 例胰腺切除术是因为临床怀疑胰腺癌而进行的。AIP 占 140 例（1.6%）。1 型 AIP 占多数，占 94%（132 例），进一步分类后 2 型 AIP 占其余 6%（8 例）。AIP 占所有不必要手术的良性疾病的近 26%，且 70%的病例为男性，而女性仅占 30%。AIP 患者的平均年龄为 59 岁。47 例 AIP 患者中有 23 例（49%）血清 CA 19-9 升高，其中 1 型 AIP 患者（51%，22/43）比 2 型 AIP 患者（25%，1/4）检测到更高水平的 CA 19-9。1 型 AIP 患者 IgG4 水平的敏感性较低（43%，49 例患者中有 21 例）。
即使采用现代诊断方法，区分 AIP 和 PDAC 仍然具有挑战性，因此在某些情况下可能会导致不必要的手术。血清 CA 19-9 水平无助于区分 AIP 和 PDAC。因此，必须努力改进诊断方法，避免不必要的复杂手术。
