Mortality and cancer risk in patients with chronic pancreatitis in japan: insights into the importance of surveillance for pancreatic cancer.
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Matsumoto Ryotaro, Kikuta Kazuhiro, Takikawa Tetsuya, Nakai Yousuke, Takenaka Mamoru, Oki Kentaro, Ohno Eizaburo, Ito Ken, Fujimori Nao, Katanuma Akio, Masuda Atsuhiro, Hori Yasuki, Ikeura Tsukasa, Suzuki Rei, Yamamoto Satoshi, Sogame Yoshio, Kawashima Hiroki, Ito Tetsuhide, Okuwaki Kosuke, Itoi Takao, Takayama Yukiko, Nakamura Akira, Terai Shuji, Matsumoto Kazuyuki, Kuwatani Masaki, Kishiwada Masashi, Shigekawa Minoru, Matsumori Tomoaki, Inatomi Osamu, Hatta Waku, Irisawa Atsushi, Unno Michiaki, Takeyama Yoshifumi, Masamune Atsushi, Japan Pancreatitis Study Group for Chronic Pancreatitis
Аннотация
METHODS: We conducted a multicenter, retrospective cohort study on 1,110 patients with CP treated at 28 institutions in 2011. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were calculated for comorbidities. Factors associated with the development of malignancy and overall survival were analyzed.
RESULTS: Patients with CP had an elevated SIR of 1.62 (95% confidence interval [CI], 1.43-1.83) for malignancy, with the highest risk observed for pancreatic cancer (SIR = 6.44 [95% CI, 4.64-8.90]). During follow-up, 143 patients (12.9%) died, most frequently from malignancy (47.5%). The SMR was elevated in all patients with CP (SMR = 1.20 [95% CI, 1.01-1.42]) and in those with alcohol-related CP (SMR = 1.49 [95% CI, 1.23-1.81]) but not in those with alcohol-unrelated CP. Pancreatic cancer was identified as the strongest factor associated with overall survival (hazard ratio, 48.92 in multivariate analysis). Overall survival of the patients with pancreatic cancer was significantly longer in those who underwent regular examinations for CP at least every three months (P = 0.011).
CONCLUSIONS: Patients with alcohol-related CP have higher mortality than the general population in Japan. Pancreatic cancer remains a crucial prognostic factor in patients with CP. Regular surveillance for pancreatic cancer is important to improve their prognosis.