The expanding cancer landscape in chronic pancreatitis.

INTRODUCTION

Chronic pancreatitis (CP) is driven by smoking, excessive alcohol use, and chronic inflammation - all known contributors to carcinogenesis. However, its association with malignancies beyond the pancreas remains underexplored. This study aimed to assess the frequency and spectrum of cancers in patients with CP.

METHOD: A retrospective cohort study was conducted at Nottingham University Hospitals of patients diagnosed with CP between 1 January 2006 and 31 December 2014, identified through a multisource case ascertainment strategy. Cancer frequencies were assessed in patients residing within Greater Nottingham. Age-adjusted standardised incidence ratios (SIRs) were calculated using national cancer incidence data from England as the reference population. Statistical analyses were performed using R (version 4.3.3).

RESULTS

Of the 1003 CP patients identified, 678 resided in Greater Nottingham (median age at diagnosis 68 years (IQR 53-79); 66% male; 92% Caucasians. The median follow-up period was 7.3 years (IQR 2.8-11.6). Compared to the general population, patients with CP demonstrated significantly higher SIRs for upper respiratory tract (12.4; 95%CI 6.6-21.1; p < 0.0001), pancreatic (10.8; 95%CI 6.2-17.6; p < 0.0001), liver (8.8; 95%CI 2.4-22.6; p < 0.0001), lung (5.6; 95%CI 4.0-7.7; p < 0.0001), renal tract (4.8; 95%CI 2.7-7.9; p < 0.0001) oesophageal (4.8; 95%CI 1.8-10.4; p = 0.0001) and colorectal (2.5; 95%CI 1.4-4.2; p = 0.0009) cancers.

CONCLUSION

CP confers a markedly elevated risk of both pancreatic and extra-pancreatic cancers. These findings hypothesise that CP might be a high-risk state for malignancy that could warrant proactive, risk-based cancer surveillance in this vulnerable population.