Risks and characteristics of pancreatic cancer and pancreatic relapse in autoimmune pancreatitis patients

Takuya Ishikawa, Hiroki Kawashima, Eizaburo Ohno, Tadashi Iida, Hirotaka Suzuki, Kota Uetsuki, Kenta Yamada, Jun Yashika, Masakatsu Yoshikawa, Noriaki Gibo, Toshinori Aoki, Kunio Kataoka, Hiroshi Mori, Mitsuhiro Fujishiro

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Background and Aim: We examined the differences in the risks and characteristics of pancreatic relapse (PR) and pancreatic cancer (PC) in patients with autoimmune pancreatitis (AIP). Methods: We retrospectively reviewed 123 type 1 AIP patients with a median follow-up of 55 months (interquartile range, 27–98). The following items were evaluated: (i) cumulative relapse rates and risk factors, (ii) the incidence of PC, (iii) PR versus PC, and (iv) outcomes after the appearance of morphological changes in the pancreas (focal enlargement, apparent mass lesions, or main pancreatic duct dilation). Results: (i) The cumulative PR rates were 1.7% within 1 year, 11.5% within 3 years, and 22.6% within 5 years. Lack of maintenance therapy, IgG4-related sclerosing cholangitis, and IgG4-related kidney disease were identified as independent predictors of relapse. (ii) Two patients (1.6%) were diagnosed with PC at 17 and 22 months after initial AIP diagnosis. (iii) Thirteen (59.1%) and four (18.2%) patients with PR had focal enlargement and main pancreatic duct dilation, respectively. The median CA19-9 level at initial diagnosis was significantly higher in PC patients (21 vs 220.5 U/mL, P = 0.014). (iv) Eight PR patients underwent endoscopic ultrasound-guided fine-needle aspiration, none of whom had malignant findings. PC was diagnosed by ultrasound-guided fine-needle aspiration in both cancer patients. Conclusions: Although the incidence of PC is low, it may mimic PR in AIP patients. Surveillance is important, and when morphological changes occur, biopsy and evaluation of serum IgG4 and CA19-9 levels (particularly if the levels were high before) should be considered.

Original languageEnglish
Pages (from-to)2281-2288
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume35
Issue number12
DOIs
Publication statusPublished - 12-2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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