Lowenfels A B, Maisonneuve P, Cavallini G, Ammann R W, Lankisch P G, Andersen J R, Dimagno E P, Andrén-Sandberg A, Domellöf L
Department of Surgery, New York Medical College, Valhalla 10595.
N Engl J Med. 1993 May 20;328(20):1433-7. doi: 10.1056/NEJM199305203282001.
The results of case-control studies and anecdotal reports suggest that pancreatitis may be a risk factor for pancreatic cancer, but there have been no studies of sufficient size and power to assess the magnitude of the relation between these two diseases.
We undertook a multicenter historical cohort study of 2015 subjects with chronic pancreatitis who were recruited from clinical centers in six countries. A total of 56 cancers were identified among these patients during a mean (+/-SD) follow-up of 7.4 +/- 6.2 years. The expected number of cases of cancer calculated from country-specific incidence data and adjusted for age and sex was 2.13, yielding a standardized incidence ratio (the ratio of observed to expected cases) of 26.3 (95 percent confidence interval, 19.9 to 34.2). For subjects with a minimum of two or five years of follow-up, the respective standardized incidence ratios were 16.5 (95 percent confidence interval, 11.1 to 23.7) and 14.4 (95 percent confidence interval, 8.5 to 22.8). The cumulative risk of pancreatic cancer in subjects who were followed for at least 2 years increased steadily, and 10 and 20 years after the diagnosis of pancreatitis, it was 1.8 percent (95 percent confidence interval, 1.0 to 2.6 percent) and 4.0 percent (95 percent confidence interval, 2.0 to 5.9 percent), respectively.
The risk of pancreatic cancer is significantly elevated in subjects with chronic pancreatitis and appears to be independent of sex, country, and type of pancreatitis.
病例对照研究结果及轶事报告表明，胰腺炎可能是胰腺癌的一个危险因素，但尚无规模和效力足以评估这两种疾病之间关联程度的研究。
我们开展了一项多中心历史性队列研究，纳入了从六个国家的临床中心招募的2015例慢性胰腺炎患者。在平均（±标准差）7.4±6.2年的随访期间，这些患者中共确诊56例癌症。根据特定国家发病率数据计算并针对年龄和性别进行调整后的癌症预期病例数为2.13，得出标准化发病率（观察病例数与预期病例数之比）为26.3（95%置信区间，19.9至34.2）。对于随访至少两年或五年的受试者，各自的标准化发病率分别为16.5（95%置信区间，11.1至23.7）和14.4（95%置信区间，8.5至22.8）。随访至少2年的受试者患胰腺癌的累积风险稳步增加，在胰腺炎诊断后10年和20年，分别为1.8%（95%置信区间，1.0至2.6%）和4.0%（95%置信区间，2.0至5.9%）。
慢性胰腺炎患者患胰腺癌的风险显著升高，且似乎与性别、国家和胰腺炎类型无关。
