Article | Published:

Pancreatic Cancer Following Acute Pancreatitis: A Population-based Matched Cohort Study

The American Journal of Gastroenterologyvolume 113pages17111719 (2018) | Download Citation

Subjects

Abstract

Background

Acute pancreatitis is linked to pancreatic cancer, but the direction of this association is not fully elaborated.

Methods

This was a population-based cohort study including all Swedish residents diagnosed with a first-time episode of acute pancreatitis between 1997 and 2013 and corresponding matched pancreatitis-free individuals from the general population. Hazard ratios for the association between acute pancreatitis and pancreatic cancer were estimated using multivariable Cox regression models.

Results

Overall, 49,749 individuals with acute pancreatitis and 138,750 matched individuals without acute pancreatitis were followed up for 1,192,134 person-years (median 5.3 years). A total of 769 individuals developed pancreatic cancer, of whom 536 (69.7%) had a history of acute pancreatitis. The risk of pancreatic cancer was substantially increased during the first few years after a diagnosis of acute pancreatitis but declined gradually over time, reaching a level comparable to the pancreatitis-free population after >10 years of follow-up. In those with non-gallstone-related acute pancreatitis, the risk of pancreatic cancer declined to a level comparable to the pancreatitis-free population only when follow-up time was censored for a second episode of acute pancreatitis or a diagnosis of chronic pancreatitis. Increasing number of recurrent episodes of acute pancreatitis was associated with increased risk of pancreatic cancer.

Conclusion

These findings imply a delay in the diagnosis of pre-existing pancreatic cancer, if clinically presented as acute pancreatitis. Any association between non-gallstone-related acute pancreatitis and pancreatic cancer in the long-term (>10 years) could be mediated through recurrent acute pancreatitis or chronic pancreatitis.

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Author information

Affiliations

  1. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden

    • Omid Sadr-Azodi MD, PhD
    • , Johan Askling MD, PhD
    •  & Anders Ekbom MD, PhD
  2. Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden

    • Omid Sadr-Azodi MD, PhD
  3. Center for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden

    • Omid Sadr-Azodi MD, PhD
  4. Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    • Viktor Oskarsson MD, PhD
  5. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    • Andrea Discacciati PhD
  6. Department of Surgery, Västerås County Hospital, Västerås, Sweden

    • Per Videhult MD

Authors

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  2. Search for Viktor Oskarsson MD, PhD in:

  3. Search for Andrea Discacciati PhD in:

  4. Search for Per Videhult MD in:

  5. Search for Johan Askling MD, PhD in:

  6. Search for Anders Ekbom MD, PhD in:

Guarantor of the article

Sadr Azodi, Omid

Specific author contributions

Study planning: All authors. Data collection: OSA. Interpretation of data: All authors. Statistical analysis: OSA, AD. Drafting the manuscript: OSA, VO. Critical revision of the manuscript for important intellectual content: All authors. All authors have approved the final draft.

Financial support

This study was supported by grants from the Swedish Society of Medicine, the Centre for Clinical Research Sörmland, Uppsala University and Uppsala-Örebro Research Council. None of the funders had any role in the study design, collection, analysis, interpretation or writing of the manuscript.

Potential competing interests

The authors declare that they have no potential competing interests.

Corresponding author

Correspondence to Omid Sadr-Azodi MD, PhD.

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DOI

https://doi.org/10.1038/s41395-018-0255-9