Pathogenesis and prognosis of tumor-induced acute pancreatitis: An analysis of 84 cases

Linlin ZHENG; Hui HE; Xiaohua KONG; Yunhui ZHOU; Ningning LIU; Lin ZHOU

doi:10.3969/j.issn.1001-5256.2022.08.027

Volume 38 Issue 8

Aug. 2022

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2022 > 38(8): 1865-1871

PDF( 1935 KB)

Pathogenesis and prognosis of tumor-induced acute pancreatitis: An analysis of 84 cases

DOI: 10.3969/j.issn.1001-5256.2022.08.027

1.
Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
2.
Henan Medical College, Zhengzhou 451191, China

Research funding:

National Natural Science Foundation of China (81001103);

Young and Middle-aged Health Science and Technology Innovation Leading Talents Training Project of Henan Province (YXKC2021017)

More Information

Corresponding author: ZHOU Lin, ZL372@126.com(ORCID: 0000-0001-5778-4844)
Received Date: 2021-12-30
Accepted Date: 2022-02-16
Published Date: 2022-08-20

Abstract

Abstract

Objective To investigate the association of biliary, pancreatic, and ampullary tumors with the onset of acute pancreatitis (AP) and the clinical features of tumor-induced AP by retrospectively analyzing the clinical data of patients with tumor-induced AP. Methods Related clinical data were collected from the patients with AP who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2013 to August 2021. The etiological composition of AP was analyzed, as well as the change in the incidence rate of tumor-induced AP; the clinical features of AP were compared between tumor-induced and non-tumor-induced AP and between the tumors at different locations to explore the pathogenesis of tumor-induced AP. For normally distributed continuous data, the t-test was used for comparison between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between two groups. For non-normally distributed continuous data, the Mann-Whitney U test was used for comparison between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test or the Fisher's exact test was used for comparison of dichotomous categorical data between groups, and the goodness-of-fit test was used for comparison of polytomous categorical data between groups. The receiver operating characteristic (ROC) curve was used to evaluate the differential factors for pancreatic tumor-induced AP, and a multivariate logistic regression analysis was used to investigate the independent predictive factors for tumor-induced AP. Results A total of 8106 patients with AP were enrolled, among whom 84 patients (1.04%) had tumor-induced AP (tumor group). The tumor group had a significantly higher mean age than the non-tumor group (t=6.050, P < 0.001). The mean time from initial onset of AP to tumor diagnosis was 7.38 months. Among the 84 patients with tumor-induced AP, 75 (89.2%) had mild AP (MAP), 8 (9.5%) had moderate severe AP, and 1(1.2%) had severe AP; as for the origin of tumor, 11(13.1%) had tumor originating from the lower biliary tract, 13(15.5%) had tumor originating from the ampulla, and 60(71.4%) had tumor originating from the pancreas. Recurrence of AP (risk ratio [RR]=8.362, 95% confidence interval [CI]: 3.162-22.115, P < 0.001), pancreatic duct dilatation (RR=10.996, 95%CI: 3.871-31.236, P < 0.001), bile duct dilatation (RR=7.738, 95%CI: 2.521-23.752, P < 0.001), and leukocyte count (RR=0.766, 95%CI: 0.666-0.881, P < 0.001) were independent predictive factors for tumor-induced AP. Conclusion Tumor-induced AP is common in middle-aged and elderly men, with the clinical manifestations of MAP, easy recurrence, pancreatic duct dilatation/bile duct dilatation, and a persistent increase in the tumor marker CA19-9. Imaging examination of the biliary, pancreatic, and ampullary regions should be enhanced for AP with the above characteristics and no apparent trigger, and follow-up should be strengthened to avoid the missed diagnosis of tumor and the influence on prognosis.
- Pancreatitis, Acute Necrotizing,
- Pathological Conditions, Signs and Symptoms,
- Digestive System Neoplasms

FullText(HTML)

References(21)

References

[1]	XIAO AY, TAN ML, WU LM, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies[J]. Lancet Gastroenterol Hepatol, 2016, 1(1): 45-55. DOI: 10.1016/S2468-1253(16)30004-8.
[2]	BOXHOORN L, VOERMANS RP, BOUWENSE SA, et al. Acute pancreatitis[J]. Lancet, 2020, 396(10252): 726-734. DOI: 10.1016/S0140-6736(20)31310-6.
[3]	PU W, LUO G, CHEN T, et al. A 5-year retrospective cohort study: epidemiology, etiology, severity, and outcomes of acute pancreatitis[J]. Pancreas, 2020, 49(9): 1161-1167. DOI: 10.1097/MPA.0000000000001637.
[4]	MCGUIGAN A, KELLY P, TURKINGTON RC, et al. Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes[J]. World J Gastroenterol, 2018, 24(43): 4846-4861. DOI: 10.3748/wjg.v24.i43.4846.
[5]	Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical. Association. Guidelines for diagnosis and treatment of acute pancreatitis in China (2021)[J]. Chin J Dig Surg, 2021, 20(7): 730-739. DOI: 10.3760/cma.j.cn115610-20210622-00297. 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021)[J]. 中华消化外科杂志, 2021, 20(7): 730-739. DOI: 10.3760/cma.j.cn115610-20210622-00297.
[6]	BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1): 102-111. DOI: 10.1136/gutjnl-2012-302779.
[7]	CHEN YH, XIE SM, ZHANG H, et al. Clinical impact of preoperative acute pancreatitis in patients who undergo pancreaticoduodenectomy for periampullary tumors[J]. World J Gastroenterol, 2015, 21(22): 6937-6943. DOI: 10.3748/wjg.v21.i22.6937.
[8]	GUDA NM, TRIKUDANATHAN G, FREEMAN ML. Idiopathic recurrent acute pancreatitis[J]. Lancet Gastroenterol Hepatol, 2018, 3(10): 720-728. DOI: 10.1016/S2468-1253(18)30211-5.
[9]	NICCOLINI DG, GRAHAM JH, BANKS PA. Tumor-induced acute pancreatitis[J]. Gastroenterology, 1976, 71(1): 142-145.
[10]	KEANE MG, HORSFALL L, RAIT G, et al. A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer[J]. BMJ Open, 2014, 4(11): e005720. DOI: 10.1136/bmjopen-2014-005720.
[11]	WANG H, KANG ZL, PENG XH, et al. Misdiagnosed analysis of severe acute pancreatitis[J]. Clin Misdiagn Misther, 2021, 34(12): 12-15. DOI: 10.3969/j.issn.1002-3429.2021.12.003. 王辉, 康志龙, 彭新华, 等. 重症急性胰腺炎误诊原因分析[J]. 临床误诊误治, 2021, 34(12): 12-15. DOI: 10.3969/j.issn.1002-3429.2021.12.003.
[12]	SINGHI AD, KOAY EJ, CHARI ST, et al. Early detection of pancreatic cancer: opportunities and challenges[J]. Gastroenterology, 2019, 156(7): 2024-2040. DOI: 10.1053/j.gastro.2019.01.259.
[13]	MUJICA VR, BARKIN JS, GO VL. Acute pancreatitis secondary to pancreatic carcinoma. Study Group Participants[J]. Pancreas, 2000, 21(4): 329-332. DOI: 10.1097/00006676-200011000-00001.
[14]	BARTELL N, BITTNER K, VETTER MS, et al. Role of endoscopic ultrasound in detecting pancreatic cancer missed on cross-sectional imaging in patients presenting with pancreatitis: a retrospective review[J]. Dig Dis Sci, 2019, 64(12): 3623-3629. DOI: 10.1007/s10620-019-05807-z.
[15]	XIONG Y, ZHAO Y, HAN X, et al. Clinical characteristics and outcome of tumor-associated acute pancreatitis: a single-center cohort study[J]. Ann Transl Med, 2021, 9(8): 639. DOI: 10.21037/atm-20-7196.
[16]	SADR-AZODI O, OSKARSSON V, DISCACCIATI A, et al. Pancreatic cancer following acute pancreatitis: a population-based matched cohort study[J]. Am J Gastroenterol, 2018, 113(11): 1711-1719. DOI: 10.1038/s41395-018-0255-9.
[17]	MATOS JM, SCHMIDT CM, TURRINI O, et al. Pancreatic acinar cell carcinoma: a multi-institutional study[J]. J Gastrointest Surg, 2009, 13(8): 1495-1502. DOI: 10.1007/s11605-009-0938-z.
[18]	CHO JH, CHOI JS, HWANG ET, et al. Usefulness of scheduled follow-up CT in discharged patients with acute pancreatitis[J]. Pancreatology, 2015, 15(6): 642-646. DOI: 10.1016/j.pan.2015.09.004.
[19]	LU XZ, HUANG SM, WEI JS. Clinical causes and imaging features of pancreatic duct dilatation[J]. Chin J Pancreatol, 2021, 21(4): 300-303. DOI: 10.3760/cma.j.cn115667-20201126-00192. 卢孝治, 黄诗朦, 卫积书. 胰管扩张的临床原因及影像学特征[J]. 中华胰腺病杂志, 2021, 21(4): 300-303. DOI: 10.3760/cma.j.cn115667-20201126-00192.
[20]	SMITH I, MONKEMULLER K, WILCOX CM. Incidentally identified common bile duct dilatation: a systematic review of evaluation, causes, and outcome[J]. J Clin Gastroenterol, 2015, 49(10): 810-815. DOI: 10.1097/MCG.0000000000000394.
[21]	FENG Q, LI C, ZHANG S, et al. Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis[J]. World J Gastroenterol, 2019, 25(39): 6006-6015. DOI: 10.3748/wjg.v25.i39.6006.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Tables(4)

Get Citation

PDF

XML

Article Metrics

Article views (406) PDF downloads(48)

Pathogenesis and prognosis of tumor-induced acute pancreatitis: An analysis of 84 cases

DOI: 10.3969/j.issn.1001-5256.2022.08.027

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content