Journal of gastroenterology · 2026
A decade of clinical course and prognostic determinants in type 1 autoimmune pancreatitis: insights from a 10-year longitudinal multicenter retrospective study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Miyazawa Masaki, Takatori Hajime, Nishitani Masaki, Komura Takuya, Kaji Kiichiro, Yano Masaaki, Kitamura Kazuya, Nakai Ryotaro, Matsukawa Hiroki, Takemura Naoki, Yanagi Masahiro, Nagai Kazuki, Kido Hidenori, Takata Noboru, Hayashi Tomoyuki, Seki Akihiro, Nio Kouki, Yamada Shinya, Iida Noriho, Shimakami Tetsuro, Yamashita Taro
Аннотация
BACKGROUND: Type 1 autoimmune pancreatitis (AIP) is a unique form of pancreatitis characterized by IgG4-related inflammation and corticosteroid (CS) responsiveness, but long-term outcomes remain unclear. We evaluated 10-year relapse, malignancy, metabolic/nutritional changes, and survival.
METHODS: We retrospectively analyzed 83 CS-treated patients with type 1 AIP followed for ≥ 10 years or until death, assessing: relapse and risk factors; standardized incidence ratios (SIRs) and risk factors for malignancies; 10-year changes in HbA1c and serum albumin; CS-related adverse events; and overall survival (OS).
RESULTS: Cumulative relapse rates at 1, 3, 5, 7, and 10 years were 11.0%, 26.9%, 38.3%, 50.0%, and 56.9%. CS discontinuation independently predicted relapse, whereas serum IgG4 normal at diagnosis or normalized after CS was protective. Overall malignancy risk was not increased (SIR 1.00; 95%CI 0.59-1.42), while pancreatic cancer (PC) showed a numerically higher SIR (1.98 overall; 2.96 ≥ 5 years postdiagnosis). In 72 patients with 10-year laboratory follow-up, HbA1c improved at 3 years but tended to worsen at 10 years, and serum albumin declined by 10 years (mean - 0.27 g/dL), exceeding age-related norms. Preexisting diabetes attenuated albumin decline. Ten-year survival was 85.5%, and CS maintenance was associated with better OS.
CONCLUSIONS: Type 1 AIP shows progressive relapse and metabolic deterioration over a decade, while CS maintenance and IgG4 normalization confer long-term protection. Although the overall risk of malignancy was not increased, the incidence of PC during late follow-up was slightly higher. These findings highlight the need for continuous monitoring for relapse, PC, and nutritional decline in AIP management.
METHODS: We retrospectively analyzed 83 CS-treated patients with type 1 AIP followed for ≥ 10 years or until death, assessing: relapse and risk factors; standardized incidence ratios (SIRs) and risk factors for malignancies; 10-year changes in HbA1c and serum albumin; CS-related adverse events; and overall survival (OS).
RESULTS: Cumulative relapse rates at 1, 3, 5, 7, and 10 years were 11.0%, 26.9%, 38.3%, 50.0%, and 56.9%. CS discontinuation independently predicted relapse, whereas serum IgG4 normal at diagnosis or normalized after CS was protective. Overall malignancy risk was not increased (SIR 1.00; 95%CI 0.59-1.42), while pancreatic cancer (PC) showed a numerically higher SIR (1.98 overall; 2.96 ≥ 5 years postdiagnosis). In 72 patients with 10-year laboratory follow-up, HbA1c improved at 3 years but tended to worsen at 10 years, and serum albumin declined by 10 years (mean - 0.27 g/dL), exceeding age-related norms. Preexisting diabetes attenuated albumin decline. Ten-year survival was 85.5%, and CS maintenance was associated with better OS.
CONCLUSIONS: Type 1 AIP shows progressive relapse and metabolic deterioration over a decade, while CS maintenance and IgG4 normalization confer long-term protection. Although the overall risk of malignancy was not increased, the incidence of PC during late follow-up was slightly higher. These findings highlight the need for continuous monitoring for relapse, PC, and nutritional decline in AIP management.