Shi Jiaqi, Nie Shuang, Shi Zhao, Liu Kun, Zhou Quan, Wang Xuan, Jiang Yihang, Zhang Song, Peng Chunyan, Lv Ying, Tang Bei, Cheng Hao, Qiu Yudong, Li Hongzhen, Yu Yuanyuan, Kong Bo, Friess Helmut, Liu Song, Wang Lei, Zou Xiaoping, Shen Shanshan
Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China.
Department of Pancreatic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China.
Surg Endosc. 2025 May;39(5):3307-3316. doi: 10.1007/s00464-025-11654-z. Epub 2025 Apr 15.
The symptoms of pancreatic cancer (PC) are usually nonspecific or absent, and the early diagnosis remains challenging. 7-14% of PC patients present initially with acute pancreatitis (AP). This study aims to distinguish the PC patients initially presenting with AP from simple AP patients, further evaluating the role of endoscopic ultrasound (EUS) in the early diagnosis.
We retrospectively evaluated 1376 consecutive patients with AP between 2010 and 2023.To overcome selection bias, we used propensity score matching between PC patients initially presenting with AP and non-cancer-related AP patients. Clinical information, especially EUS were collected for comparison.
After matching, 72 patients (PC group) and 216 patients (AP group) were included. The unknown etiology in the PC group was significantly higher than that in the AP group (54.2% vs. 27.8%). Regarding initial symptoms, non-cancer-related AP patients exhibited significantly more abdominal distension, vomiting and fever compared to the PC group (p < 0.05). In terms of lab results, PC group patients had lower serum amylase (p < 0.001), but higher CA19-9, CA72-4, and CA242 levels when compared to AP group patients (p < 0.001). Additionally, AP group patients had more systematic and local complications, and the severity of AP was much higher than that of PC group patients. Moreover, PC patients exhibited more frequent imaging findings, such as pancreatic duct dilation or atrophy, and enlarged lymph nodes (p < 0.05). Notably, the EUS examination in PC patients missing diagnosis initially and PC patients presenting with relapsed AP showed more sensitive results and more detective rates.
Pancreatic cancer patients presenting initially with acute pancreatitis tend to exhibit mild, recurrent pancreatitis than common AP patients. EUS holds potential diagnostic value in detecting pancreatic cancer in patients with initially negative cross-sectional imaging and recurrent pancreatitis.
胰腺癌（PC）的症状通常不具有特异性或无症状，早期诊断仍然具有挑战性。7% - 14%的PC患者最初表现为急性胰腺炎（AP）。本研究旨在区分最初表现为AP的PC患者与单纯AP患者，进一步评估内镜超声（EUS）在早期诊断中的作用。
我们回顾性评估了2010年至2023年间连续收治的1376例AP患者。为克服选择偏倚，我们对最初表现为AP的PC患者和非癌症相关AP患者进行倾向得分匹配。收集临床信息，尤其是EUS信息进行比较。
匹配后，纳入72例患者（PC组）和216例患者（AP组）。PC组中病因不明的比例显著高于AP组（54.2%对27.8%）。关于初始症状，与PC组相比，非癌症相关AP患者腹胀、呕吐和发热更为明显（p < 0.05）。在实验室检查结果方面，与AP组患者相比，PC组患者血清淀粉酶水平较低（p < 0.001），但CA19 - 9、CA72 - 4和CA242水平较高（p < 0.001）。此外，AP组患者出现的全身和局部并发症更多，AP的严重程度远高于PC组患者。而且，PC患者出现影像学表现的频率更高，如胰管扩张或萎缩以及淋巴结肿大（p < 0.05）。值得注意的是，最初漏诊的PC患者和复发AP的PC患者的EUS检查结果更敏感，检出率更高。
最初表现为急性胰腺炎的胰腺癌患者往往比普通AP患者表现出轻度、复发性胰腺炎。EUS在检测最初横断面成像阴性和复发性胰腺炎患者的胰腺癌方面具有潜在的诊断价值。
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