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Acute pancreatitis may be predictor of pancreatic adenocarcinoma
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Many patients with pancreatic adenocarcinoma initially presented with an episode of acute pancreatitis, and as long as 2 years elapsed between diagnoses, according to results of a retrospective study.
The correlation appeared particularly strong in patients older than 40 years when diagnosed with acute pancreatitis.
Researchers evaluated health records of 495,504 patients who presented for care between 1998 and 2007 at the Veterans Health Administration. Those with pre-existing pancreatic adenocarcinoma were excluded from the analysis.
Researchers determined that 5,720 (1.15%) patients were diagnosed with acute pancreatitis and 710 (0.14%) were diagnosed with pancreatic adenocarcinoma between 2000 and 2007. Of those diagnosed with pancreatic adenocarcinoma, 76 had presented with acute pancreatitis within 2 years of adenocarcinoma diagnosis.
Results showed the risk for developing adenocarcinoma was highest in the first year after pancreatitis diagnosis (14.5 per 1,000 patient-years) and was significantly lower thereafter.
The risk appeared negligible among patients younger than 40 years. Among those older than 40 years, the prevalence of adenocarcinoma within the first year after pancreatitis diagnosis was 7.69 per 1,000 patient-years. The incidence after the seventh decade of life increased to 28.67 per 1,000 patient-years.
Banke Agarwal
The time to adenocarcinoma diagnosis after pancreatitis diagnosis was 2 months or less for 34 of the patients, 3 to 12 months for 35 patients, 13 to 24 months for seven patients, and more than 24 months for 10 patients.
Adults older than 40 years who are diagnosed with pancreatitis should undergo esophageal ultrasound to test for pancreatic adenocarcinoma, according to researcher Banke Agarwal, MD, associate professor of gastroenterology and hepatology at Saint Louis University, and colleagues.
“As a point of reference, it’s useful to consider that the relative number of patients with acute pancreatitis who are subsequently diagnosed with pancreatic cancer is greater than that of cancer discovered during colonoscopy screening,” Agarwal said in a press release.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopDerek Raghavan, MD, PhD, FACP, FRACP, FASCO
The study from Munigala and the accompanying comment from Agarwal are interesting, and again show the potential association between acute pancreatitis and the development of subsequent pancreatic cancer. Agarwal has suggested that adults aged older than 40 years with acute pancreatitis should undergo esophageal ultrasonography to screen for pancreatic cancer. However, I think one needs to be careful in recommending an expensive screening protocol without more defined evidence — as noted, the risk of developing adenocarcinoma was 0.0145 per patient-year, and the costs of screening the 5,720 identified patients with acute pancreatitis by ultrasound would be high; the problem here is that this comment does not address the stage of the cancers at diagnosis, nor whether the potentially earlier diagnosis improved the cure rate, and one would need evidence of survival benefit before committing to a costly and labor-intensive standard approach. It should be remembered that the key aim of any screening technology is to improve OS, not just to identify a tumor earlier in a natural history pathway that is not changed. If this approach led to a higher proportion of cancers that could be cured surgically, it would make sense.
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