Abstract A044: Incidence and risk of pancreatic cancer in patients with chronic pancreatitis: define optimal subgroup for surveillance

Abstract

Abstract Background/Aims: Patients with chronic pancreatitis (CP) have an increased risk of developing pancreatic cancer. The true incidence of pancreatic cancer in CP patients in South Korea remains unclear, and reliable methods for identifying patients with CP at increased risk for pancreatic cancer are still lacking. We aimed to present the incidence and risk factors of pancreatic cancer in a multicenter retrospective cohort of patients with CP. Methods: Patients with ICD-10 code for CP (K86.0, K86.1) who underwent abdominal CT or MRI between January 2010 and December 2021 in seven academic hospitals were retrospectively analyzed. Patients who did not have definite CP, had follow-up less than 1 year, and developed pancreatic cancer less than 1 year after diagnosis of CP were excluded. A standardized incidence ratio was demonstrated using the incidence of pancreatic cancer in all populations in South Korea. Risk factors of pancreatic cancer were determined in patients with CP using the Cox-proportional hazards model. Results: After exclusions, we identified 727 patients with definite CP with a median follow-up of 3.6 years. There were 588 (80.9%) males and 139 (19.1%) females (median age 56.5 years, range 18-93). During 3,290 person-years of observation, 16 pancreatic cancers (2.20%, 0.49% year) were diagnosed after a median follow-up of 2.4 years (range 1.4-6.5); 5 (31%) developed between 1 and 2 years, 4 (25%) between 2 and 3 years, 3 (19%) between 3 and 4 years, and 3 (25%) between 4-7 years. Age and sex-standardized incidence ratio of pancreatic cancer was 18.1 (95% CI 10.4-29.5). Patients with pancreatic cancer were older (p = 0.008), more experienced exacerbation of pancreatitis (p = 0.031), had less parenchymal calcification (p = 0.009), and had higher CA 19-9 levels (p < 0.001) compared to those without pancreatic cancer. Among 16 developed pancreatic cancers, underlying CPs were 10 (63%) chronic obstructive pancreatitis, 4 (25%) chronic obstructive and calcifying pancreatitis, 1 (6%) chronic calcifying pancreatitis, and 1 (6%) autoimmune pancreatitis. Factors associated with pancreatic cancer development included age (hazard ratio 4.830, 95% CI 1.556-14.99, p = 0.006), parenchymal calcification (hazard ratio 0.213, 95% CI 0.077-0.586, p = 0.003), pancreatic duct stricture (hazard ratio 2.706, 95% CI 1.007-7.271, p = 0.048), and CA 19-9 level (hazard ratio 22.49, 95% CI 6.272-80.67, p <0.001). By multivariable analysis, age (hazard ratio 5.580, 95% CI 1.604-19.41, p = 0.007) and CA 19-9 level (hazard ratio 25.56, 95% CI 7.022-93.06, p <0.001) were the independent risk factors for pancreatic cancer. Conclusions: Patients with CP have a high risk of developing pancreatic cancer in South Korea. High risks in CP patients with more 60-year age at CP diagnosis and high CA 19-9 level warrant careful surveillance for pancreatic cancer. Citation Format: Seunghwan Noh, Jae Hyuck Chang. Incidence and risk of pancreatic cancer in patients with chronic pancreatitis: define optimal subgroup for surveillance [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A044.