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Meta-Analysis
. 2022 Mar 28;13(3):e00463.
doi: 10.14309/ctg.0000000000000463.

Chronic Pancreatitis Is a Risk Factor for Pancreatic Cancer, and Incidence Increases With Duration of Disease: A Systematic Review and Meta-analysis

Sonal Gandhi  1 , Jaime de la Fuente  2 , Mohammad Hassan Murad  3 , Shounak Majumder  2
Affiliations
Meta-Analysis

Chronic Pancreatitis Is a Risk Factor for Pancreatic Cancer, and Incidence Increases With Duration of Disease: A Systematic Review and Meta-analysis

Sonal Gandhi et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Observational studies have suggested an increased risk of pancreatic ductal adenocarcinoma (PDAC) in patients with acute and chronic pancreatitis. We conducted a systematic review and meta-analysis to evaluate the magnitude of this association and summarize the published epidemiological evidence.

Methods: We searched electronic databases (MEDLINE, Embase, Web of Science, Cochrane, and Scopus) and reference lists until January 18, 2021. Studies reporting quantitative association between pancreatitis and PDAC were included and assessed for eligibility, data abstraction, and risk of bias. Standardized incidence ratios (SIRs) were pooled using the random-effects model.

Results: Twenty-five cohort and case-control studies met inclusion criteria. Meta-analysis of 12 chronic pancreatitis (CP) studies demonstrated an increased risk of PDAC in patients with CP (SIR: 22.61, 95% confidence interval [CI]: 14.42-35.44). This elevated risk persisted in subgroup analysis of studies that excluded patients diagnosed with PDAC within 2 years of CP diagnosis (SIR: 21.77, 95% CI: 14.43-32.720). The risk was higher in hereditary pancreatitis (SIR: 63.36, 95% CI: 45.39-88.46). The cumulative incidence rates of PDAC in CP increased with follow-up duration. Limited evidence in acute pancreatitis indicates higher PDAC risk in the subset of patients eventually diagnosed with CP. PDAC seems to be uncommon in patients with autoimmune pancreatitis, with 8 reported cases in 358 patients with autoimmune pancreatitis across 4 studies.

Discussion: There is an increased risk of PDAC in patients with CP, and incidence rates increase with CP disease duration. Our results indicate that PDAC surveillance may be considered in individuals with long-standing CP.

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Conflict of interest statement

Guarantor of the article: Shounak Majumder, MD.

Specific author contributions: S.G.: study concept and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript. J.d.l.F: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript for important intellectual content. M.H.M.: study concept and design, analysis and interpretation of data, statistical analysis, and critical revision of manuscript for important intellectual content. S.M.: study concept and design, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript for important intellectual content, and study supervision.

Financial support: None to report.

Potential competing interests: Mayo Clinic and Exact Sciences have an intellectual property development agreement. S.M. is listed as an inventor under this agreement and could share potential future royalties paid to Mayo Clinic. The other authors declare no conflict of interest.

Data, analytic methods, and study materials pertinent to this manuscript may be made available to other researchers on reasonable request.

Figures

Figure 1.
Figure 1.
Study flowchart for selection criteria.
Figure 2.
Figure 2.
Forest plots of the observational studies examining the association between CP, HP, and PDAC risk. CI, confidence interval; CP, chronic pancreatitis; HP, hereditary pancreatitis; PDAC, pancreatic ductal adenocarcinoma; SIR, standardized incidence ratio.
Figure 3.
Figure 3.
Forest plots of the observational studies comparing the SIR of pancreatic ductal adenocarcinoma in chronic pancreatitis for smokers vs nonsmokers. CI, confidence interval; SIR, standardized incidence ratio.
Figure 4.
Figure 4.
Cumulative incidence rate of pancreatic ductal adenocarcinoma after diagnosis of chronic pancreatitis.
Figure 5.
Figure 5.
Funnel plot assessing publication bias.
See this image and copyright information in PMC

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