The expanding cancer landscape in chronic pancreatitis.

Alcohol and cigarettes: Partners in crime in chronic pancreatitis

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.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

The current study examined demographics, sexual orientation, gender characteristics, and gender minority stress and their association to excessive alcohol, cannabis, and illicit (noncannabis) drug use among 1210 transgender adults living in the United States. The authors conducted a secondary analysis of data that included 680 transgender women (M age=32.63, SD age=12.29) and 530 transgender men (M age=26.14, SD age=7.42). A modified version of the Risk Behavioral Assessment quantified participants' alcohol, cannabis, and illicit drug use in the past 3months. Overall, 21.5% of participants reported excessive alcohol use; no significant differences were found on the rates of excessive alcohol use between transgender women and men. Cannabis use among our sample was 24.4%; trangender men reported significantly higher rates of cannabis use compared to transgender women. Illicit drug (noncannabis) use among our sample was 11.6%; transgender men also reported significantly higher rates of illicit drug use compared to transgender women. Multivariate analyses suggested that gender dysphoria was significantly associated with: excessive alcohol use for transgender women, cannabis use among both transgender women and men, and illicit (noncannabis) drug use among transgender women. A nonheterosexual orientation was associated with increased odds of cannabis use among transgender women and men; a nonheterosexual orientation was associated with greater odds of illicit substance use among transgender men but not among transgender women. Genderminority stressors were independently associated with excessive alcohol use among transgender men and cannabis use among transgender women. The authors suggest that minority stress may only partially account for substance use among transgender people. Consequently, the authors suggest that in addition to minority stress, other biopsychosocial mechanisms should continue to be examined to identify pathways that may lead to the development of effective substance use prevention efforts and treatment programs.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have advanced the treatment of type 2 diabetes mellitus (T2DM), yet their association with cancer risk remains subject of ongoing research. Chronic pancreatitis (CP) is a well-established risk factor for pancreatic cancer, yet the impact of GLP-1 RA therapy in this high-risk population is unknown. In this study, we aimed to evaluate the association between GLP-1 RA use and pancreatic cancer incidence among patients with CP, and among those with CP and T2DM. Methods: We performed a retrospective cohort study using data from TriNetX, a healthcare database of over 150 million patients in the United States. In the first analysis, adult patients with pre-existing CP were identified and stratified by use of a GLP-1 RA (semaglutide, dulaglutide, tirzepatide, exenatide, liraglutide, lixisenatide, and albiglutide). Propensity score matching (PSM) was conducted between GLP1-RA users and non-users, matching for age, sex, race, tobacco use, alcohol use, hypertension, hyperlipidemia, obesity, and pancreatic cysts. Five-year incidence of pancreatic cancer was compared between GLP-1 RA users and non-users in the matched cohort between 2015 and 2025. We then restricted the cohort to patients with CP and T2DM and repeated this analysis. Results: We identified 89,596 patients with CP, including 3183 GLP-1 RA users and 86,413 non-users. After PSM, GLP-1 RA use was associated with a lower 5-year incidence of pancreatic cancer (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.30-0.80, p < 0.005). Similarly, amongst patients with CP and T2DM, GLP-1 RA use was associated with a lower 5-year incidence of pancreatic cancer (HR 0.53, 95% CI 0.31-0.91, p < 0.05). Conclusions: GLP-1 RA use was associated with a significantly reduced incidence of pancreatic cancer in all patients with CP, as well as the subpopulation with both CP and T2DM. Given the elevated cancer risk in CP, these findings suggest a potential beneficial effect of GLP-1RA use in this high-risk population. Prospective studies will be important to further analyze and confirm this potential benefit.

Background: Although most epidemiological studies do not support a role for alcohol in the aetiology of pancreatic cancer, an increased risk among heavy drinkers cannot be excluded. Methods: In a...

Alcohol use and clinical manifestations of tuberculosis

Can histopathology be the “Gold Standard” for diagnosing autoimmune pancreatitis?

Chronic pancreatitis (CP) is a known risk factor for pancreatic cancer; however its association to extra pancreatic (EP) cancers remains inadequately explored. The aim of this systematic review is to investigate the evidence for CP as a risk factor for developing EP cancers. Electronic search was conducted on Ovid Medline, EMBASE and Scopus from inception to January 27, 2024 to identify patients with CP who developed EP cancers. Prevalence and incidence of each cancer were calculated where possible from the reported numbers. A random effects meta-analysis was used to pool prevalence, incidence and hazard ratios (HR) of each EP cancer. Heterogeneity was assessed using I2. PROSPERO registration: CRD42024543050. Sixteen (16) studies consisting of 117,163 CP patients met the eligibility criteria. 4015 (3.4%) patients developed 4019 EP cancers. The overall annual prevalence and incidence of EP cancers were 7962 (95% CI 5044-10880) per 100,000 CP patients and 1039 (95% CI 649-1663) per 100,000 person years. Lung cancer had the highest annual prevalence - (1540 (95% CI 667-2413) per 100,000 CP patients) and incidence (260 (95% CI 120-390) per 100,000 person years). The pooled HR were 1.31 (95% CI 1.03-1.66) and 1.58 (95% CI 1.27-1.98) for adjusted lung cancer and crude liver cancer in patients with CP compared to patients without CP, respectively. Patients with CP have an increased risk of developing EP cancers compared to patients without CP, in particular lung and liver cancer which had the highest relative risk. Shared risk factor modifications, such as smoking cessation and alcohol reduction, could lower the risk of common EP cancers. Further, implementing non-invasive screening measures may aid in early diagnosis in this high-risk group.

BACKGROUNDAlthough some experimental studies have indicated that cholecystectomy may increase the risk of pancreatic cancer, data from epidemiological studies are conflicting.AIMSWe conducted a register based retrospective cohort study to explore...

Metastatic pancreatic adenocarcinoma associated with chronic calcific pancreatitis and a heterozygous SPINK1 N34S mutation

Since chronic alcohol use suppresses the adult immune system, we tested the hypothesis that maternal alcohol ingestion increases the risk of infection in term newborns. Analysis of a large case-control study of birth weight for gestational age was performed focusing on maternal alcohol ingestion and the development of infection in term newborns > or =36 weeks gestation. After delivery, mothers were asked about alcohol and tobacco use in the 3 months prior to conception, the 1st, 2nd, and 3rd trimester of pregnancy. Eight hundred and seventy-two singleton newborns (872) > or = 36 weeks gestation were identified for analysis. A total of 51 (5.8%) had newborn infections. Gestational age, sex, and small for gestational age (SGA) were similar in the newborns with and without infection (p = NS). Infants whose mothers reported alcohol use, excessive drinking or smoking in pregnancy were more likely to have a newborn diagnosed with an infection than were mothers who reported abstaining from alcohol or cigarettes (p < 0.05). When controlling for race and smoking, SGA infants whose mothers used any alcohol had a 2.5-fold increase risk of infection, while excessive alcohol use increased the risk 3-4-fold. In a multivariable logistic regression analysis controlling for low maternal income, smoking, and SGA, excessive alcohol use during the 2 trimester increased the risk of newborn infection (OR 3.7 [1.1,12.8], p < 0.05). Excessive maternal alcohol use is associated with an increased risk of newborn infection in this patient sample. Increased awareness and further clinical investigations are warranted to address the detrimental effects of fetal alcohol exposure on the developing immune system.

To examine the impact of diabetes duration, chronic pancreatitis and other factors on pancreatic cancer risk. This retrospective cohort study using the UK General Practice Research Database compared pancreatic cancer incidence and risk in patients with type 2 diabetes mellitus (T2DM) versus patients without diabetes. Multivariate Cox regression adjusting for age, sex, history of chronic pancreatitis, gallbladder disease, obesity, smoking and alcohol use and Charlson comorbidity index was used to estimate hazard ratio (HR) [95% confidence interval, CI]. Analyses were repeated using various time windows for diabetes duration. A total of 1903 incident pancreatic cancers were identified, 436 in patients with T2DM (78.76 per 100 000 person-years [95% CI: 71.54, 86.51]) and 1467 in patients without diabetes (11.46 per 100 000 person-years [10.88, 12.06]). Pancreatic cancer risk was significant for T2DM (adjusted HR 1.80 [1.52, 2.14]), increasing age, history of chronic pancreatitis and tobacco use. For patients with chronic pancreatitis and T2DM, the adjusted HR was 12.12 [6.02, 24.40]. Incidence was highest in patients with ≥5 year duration of T2DM. In patient populations with duration of T2DM ranging from ≥1 to ≥5 years, adjusted HRs remained significant but point estimates attenuated slightly with longer duration of T2DM. Patients with T2DM had an 80% increased risk of pancreatic cancer versus patients without diabetes. Patients with T2DM and chronic pancreatitis were 12 times more likely to develop pancreatic cancer.

Yes, Simultaneous Damage to Both the Pancreas and Liver Are Associated in Subjects Who Drink Excessive Amounts of Alcohol!

e are so focused on insulin production that it is easy to forget the rest of the pancreas. The pancreas lies hidden behind the stomach at the back of the abdomen, adjacent to the duodenum, spleen, vena cava, aorta and other vessels, and the common bile duct. Pancreatic disorders may produce few or confusing symptoms. The pancreas is challenging to study, not only because of its anatomical position, but because it digests itself soon after removal from the body.