背景:胆道癌(BTC)通常直到晚期才被发现,导致预后不良。鉴于胆囊和胆管与胰腺的解剖接近,急性胰腺炎引发的炎症过程可能会增加BTC的风险.
目的:评估急性胰腺炎与BTC风险之间的关系。
方法:使用瑞典胰腺炎队列(SwePan),我们比较了1990-2018年首次急性胰腺炎发作患者与1:10匹配的无胰腺炎对照组的BTC风险.多变量Cox回归模型,按随访时间分层,用于计算危险比(HR),适应社会经济因素,酒精使用,和合并症。
结果:BTC在85,027例急性胰腺炎患者中为0.94%,在814,993例对照中为0.23%。BTC风险在出院后3个月内显著增加(HR82.63;95%CI:63.07-108.26),并且在随访10年后仍保持升高(HR1.82;95%CI:1.35-2.47)。然而,BTC亚型的长期风险并没有随着解剖接近胰腺而增加,与胆囊和肝外肿瘤无关。重要的是,急性胰腺炎患者出院后2年内早期BTC的发生率高于对照组(13.0vs.3.6%;p值<0.01)。
结论:我们的全国性研究发现急性胰腺炎患者的BTC风险升高;然而,对BTC亚型的风险估计不一致,从而质疑关联的因果关系。重要的是,在诊断为急性胰腺炎后2年内,早期BTC的检测增加,这凸显了对这些患者进行主动BTC监测的必要性.
BACKGROUND: Biliary tract cancer (BTC) often goes undetected until its advanced stages, resulting in a poor prognosis. Given the anatomical closeness of the gallbladder and bile ducts to the pancreas, the inflammatory processes triggered by acute pancreatitis might increase the risk of BTC.
OBJECTIVE: To assess the association between acute pancreatitis and the risk of BTC.
METHODS: Using the Swedish Pancreatitis Cohort (SwePan), we compared the BTC risk in patients with a first-time episode of acute pancreatitis during 1990-2018 to a 1:10 matched pancreatitis-free control group. Multivariable Cox regression models, stratified by follow-up duration, were used to calculate hazard ratios (HRs), adjusting for socioeconomic factors, alcohol use, and comorbidities.
RESULTS: BTC developed in 0.94% of 85,027 acute pancreatitis patients and in 0.23% of 814,993 controls. The BTC risk notably increased within 3 months of hospital discharge (HR 82.63; 95% CI: 63.07-108.26) and remained elevated beyond 10 years of follow-up (HR 1.82; 95% CI: 1.35-2.47). However, the long-term risk of BTC subtypes did not increase with anatomical proximity to the pancreas, with a null association for gallbladder and extrahepatic tumors. Importantly, patients with acute pancreatitis had a higher occurrence of early-stage BTC within 2 years of hospital discharge than controls (13.0 vs. 3.6%; p-value <0.01).
CONCLUSIONS: Our nationwide study found an elevated BTC risk in acute pancreatitis patients; however, the risk estimates for BTC subtypes were inconsistent, thereby questioning the causality of the association. Importantly, the amplified detection of early-stage BTC within 2 years after a diagnosis of acute pancreatitis underscores the necessity for proactive BTC surveillance in these patients.