Pancreatitis before pancreatic cancer: clinical features and influence on outcome.
Pancreatitis before pancreatic cancer: clinical features and influence on outcome.
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DOI：
10.1097/mcg.0b013e3182a9f879
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发表时间：
2014-10
影响因子：
2.9
通讯作者：
Faigel DO
中科院分区：
文献类型：
--
作者：
Dzeletovic I;Harrison ME;Crowell MD;Pannala R;Nguyen CC;Wu Q;Faigel DO
胰腺炎被认为是胰腺癌（PA）的可能危险因素和表现。我们的目的是评估大型 PA 患者登记，以确定既往胰腺炎病史是否影响生存。我们回顾性分析了 1992 年 1 月至 2011 年 9 月的 Mayo Clinic 胰腺研究生物样本资源数据库。收集的数据包括人口特征、吸烟或饮酒史、糖尿病 (DM)、胆石症、假性囊肿以及有关 PA 的详细信息。将患有胰腺炎的 PA 患者的临床特征和结果与无胰腺炎病史的 PA 患者进行比较。我们分析了 2,573 名 PA 诊断患者。在这些患者中，有 195 名 (8%) 在 PA 诊断前 ≥10 天被诊断为胰腺炎。有胰腺炎病史的队列包括更多的糖尿病患者（30% vs. 18%；P<.001）和更多的吸烟者（68% vs. 58%；P=.02）。与无胰腺炎病史的患者相比，这些患者接受 PA 诊断的年龄更小（63 岁 vs. 65 岁；P=0.005）且分期更早（I 期和 II 期；52% vs. 37%；P<0.001）。更大比例的人有以治疗为目的的手术史（50% vs. 43%；P=.001），并且生存期明显更好（中位[范围]，387 [314–460] 天 vs. 325 [306–344] 天；P=.003）。患有 PA 和胰腺炎的患者体重减轻和 DM 较多，但在较早阶段进行 PA 诊断，更有可能进行胰腺手术，因此比不患有胰腺炎的 PA 患者生存率更高，这可能是由于早期诊断所致。需要进一步的研究来评估对有胰腺炎病史的患者进行 PA 筛查是否会带来生存获益。
Pancreatitis is considered a possible risk factor for and a presentation of pancreatic adenocarcinoma (PA). We aimed to evaluate a large PA patient registry to determine whether prior history of pancreatitis influenced survival. We retrospectively analyzed the Mayo Clinic Biospecimen Resource for Pancreas Research database from January 1992 to September 2011. Data collected included demographic characteristics, history of tobacco or alcohol use, diabetes mellitus (DM), cholelithiasis, pseudocyst, and details regarding PA. Clinical characteristics and outcomes of PA patients with pancreatitis were compared to PA patients without pancreatitis history. We analyzed 2,573 patients with PA diagnosis. Among these patients, 195 (8%) were identified who had pancreatitis diagnosis ≥10 days before PA diagnosis. The cohort with pancreatitis history included more patients with DM (30% vs. 18%; P<.001) and more smokers (68% vs. 58%; P=.02). Compared with patients without pancreatitis history, these patients received diagnoses of PA at a younger age (63 vs. 65 years; P=.005) and earlier stage (stage I and II; 52% vs. 37%; P<.001). A greater percentage had history of surgery with curative intent (50% vs. 43%; P=.001) and significantly better survival (median [range], 387 [314–460] days vs. 325 [306–344] days; P=.003). Patients with PA and pancreatitis had more weight loss and DM, but had PA diagnosis at an earlier stage, were more likely to have pancreatic surgery, and therefore better survival than PA patients without pancreatitis, likely due to the earlier diagnosis. Further studies are needed to evaluate whether screening for PA in patients with pancreatitis history would provide survival benefit.