Gallstone disease may be predictor of pancreatic cancer
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Patients with pancreatic ductal adenocarcinoma were six times more likely to have had cholelithiasis or cholecystitis in the year before diagnosis compared with the general population, according to data presented at Digestive Disease Week.
“Pancreatic cancer is often fatal, because it is frequently not diagnosed until its later stages. What complicates the initial diagnosis is that early symptoms often mirror those associated with gallstone disease and gallbladder inflammation, both of which have been demonstrated to be risk factors for pancreatic cancer,” Teviah E. Sachs, MD, MPH, associate professor and chief of surgical oncology at Boston Medical Center, said at the DDW media briefing. “Unfortunately, there is little known about how often these conditions occur before the diagnosis of pancreatic cancer.”
Using health records from the SEER-Medicare database, investigators assessed the incidence of hospital visits for gallstone disease and cholecystectomy within the year prior to cancer diagnosis. They compared their findings with annual incidence in a non-cancer cohort.
From 2008 to 2015, investigators identified 18,700 patients with pancreatic ductal adenocarcinoma (median age, 76 years; 52.8% women; 49% stage IV disease), of whom 4.7% had gallstone disease and 1.6% underwent cholecystectomy in the year prior to diagnosis. They also identified an average of 99,287 non-cancer patients per year, of whom 0.8% had gallstone disease per year and 0.3% underwent cholecystectomy per year. According to study results, patients with gallstone disease had an earlier stage diagnosis (stage I-II: 47.9% vs. 40.5%; P < .0001) and an increased rate of pancreaticoduodenectomy (17.6% vs. 12.9%; P < .0001) compared with those without gallstone disease.
“Understanding this association between gallstone disease and pancreatic cancer might be a key to improving differential diagnosis strategies that help combat the high mortality rate by providing an opportunity for earlier diagnosis and treatment,” Sachs said.
Perspective
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Prabhleen Chahal, MD, FASGE, FACG, AGAF
Pancreatic cancer is the third leading cause of fatal malignancy in the U.S with increasing incidence. Several risk factors implicated in the etiology of pancreatic cancer have been identified, and recent emerging data elaborate on the role of gut dysbiosis in the gut-pancreas-liver axis as the cause of pancreatic ailments, including gallstones and pancreatic cancer.
In this study, the finding of six times higher incidence of gallstones and cholecystitis in patients with pancreatic cancer is not surprising and endorses the accumulating evidence derived from metabolomic analyses that gut microbiome and dysbiosis thereof is responsible for several pancreatobiliary ailments.
Further research is needed to identify the metabolomic pathways implicated in both gallstone formation and pancreatic cancer so that directed intervention in these pathways can be implemented for prophylaxis and cure.
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Papageorge M, et al. Abstract 761. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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