Risk of Cancer in Patients With Autoimmune Pancreatitis
Risk of Cancer in Patients With Autoimmune Pancreatitis
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DOI：
10.1038/ajg.2012.465
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发表时间：
2013-04-01
影响因子：
9.8
通讯作者：
Chiba, Tsutomu
中科院分区：
文献类型：
--
作者：
Shiokawa, Masahiro;Kodama, Yuzo;Chiba, Tsutomu
目的：虽然偶尔观察到自身免疫性胰腺炎（AIP）和癌症同时发生，但癌症和AIP是独立发生还是相互关联，在很大程度上仍然是未知的。这项研究的目的是研究AIP和癌症之间的关系。方法：我们进行了一项多中心、回顾性队列研究。108名符合亚洲AIP诊断标准的患者被纳入研究。我们计算了AIP患者的比例、标准化发病率（SIR）、相对风险和癌症发展的时间进程。我们还分析了AIP伴癌患者与无癌患者的临床病理特征。结果：在108例AIP患者中，15例患者（13.9%）在3.3年的中位随访期间发现18例癌症。癌症的SIR为2.7(95%可信区间（CI） 1.4-3.9)，在AIP诊断后的第一年（6.1 (95% CI 2.3-9.9)）和随后的几年（1.5 (95% CI 0.3-2.8)）分层。AIP诊断时AIP患者的相对癌症风险为4.9 （95% CI 1.7-14.9）。在皮质类固醇治疗AIP前可以评估癌症病变的8例患者中，有6例在癌间质中观察到丰富的igg4阳性浆细胞浸润。这6例患者在癌症治疗成功后没有AIP复发。结论：AIP患者发生各种癌症的风险较高。AIP诊断后第一年的癌症风险最高，并且在成功治疗共存的癌症后没有AIP复发，这表明AIP可能在一些患者中发展为副肿瘤综合征。
OBJECTIVES: Although simultaneous occurrences of autoimmune pancreatitis (AIP) and cancer are occasionally observed, it remains largely unknown whether cancer and AIP occur independently or these disorders are interrelated. The aim of this study was to examine the relationship between AIP and cancer.METHODS: We conducted a multicenter, retrospective cohort study. One hundred and eight patients who met the Asian diagnostic criteria for AIP were included in the study. We calculated the proportion, standardized incidence ratio (SIR), relative risk, and time course of cancer development in patients with AIP. We also analyzed the clinicopathological characteristics of AIP patients with cancer in comparison with those without cancer.RESULTS: Of the 108 AIP patients, 18 cancers were found in 15 patients (13.9%) during the median follow-up period of 3.3 years. The SIR of cancer was 2.7 (95% confidence interval (CI) 1.4-3.9), which was stratified into the first year (6.1 (95% CI 2.3-9.9)) and subsequent years (1.5 (95% CI 0.3-2.8)) after AIP diagnosis. Relative risk of cancer among AIP patients at the time of AIP diagnosis was 4.9 (95% CI 1.7-14.9). In six of eight patients whose cancer lesions could be assessed before corticosteroid therapy for AIP, abundant IgG4-positive plasma cell infiltration was observed in the cancer stroma. These six patients experienced no AIP relapse after successful cancer treatment.CONCLUSIONS: Patients with AIP are at high risk of having various cancers. The highest risk for cancer in the first year after AIP diagnosis and absence of AIP relapse after successful treatment of the coexisting cancers suggest that AIP may develop as a paraneoplastic syndrome in some patients.