| Objective: Chronic pancreatitis is currently considered as one of the risk factors for pancreatic cancer,and there is a huge difference between the two in treatment and prognosis.Pancreatic cancer in patients with chronic pancreatitis is usually insidious,and its symptoms and clinical manifestations are similar to those of chronic pancreatitis.Screening the risk factors closely related to the occurrence of pancreatic cancer in chronic pancreatitis and the study on the risk factors of early pancreatic cancer are both hot topics in the academic circle.Based on the above purposes,we designed two studies.Methods: The first part was a retrospective cohort study,111 chronic pancreatitis patients with complete clinical data were selected from more than 5000 chronic pancreatitis patients admitted to the hospital from June 2011 to November 2020,who had been in the hospital for more than 3 times and the interval between the first and last visits was > 2 years.Among them,15 patients were pathologically diagnosed as pancreatic cancer in the later follow-up visit.The first hospitalization data of patients were collected,followed up by telephone,and the later treatment was further improved.The general data,examination and imaging data of the enrolled patients were recorded in detail and the radiologists were invited to mark them.The independent risk factors were analyzed by logistic regression analysis,and the prediction model of cancer patients with chronic pancreatitis was established and verified internally.Further,the patients were divided into10 subgroups according to the five characteristics of smoking history,drinking history,acute pancreatitis history,diabetes and gender.Multivariate logistic regression analysis was conducted for each subgroup to evaluate the risk factors or protective factors of different subgroups.The second part of the study was a case-control study of early pancreatic cancer with pancreatic tissue fibrosis.A total of 13 patients with stage 0 and IA pancreatic cancer confirmed by pathological diagnosis of surgical specimens from June 2015 to December2020,and 23 patients in the non-cancer group were collected.Baseline data and main clinical data were collected for a control study.Independent risk factors associated with early pancreatic cancer were analyzed by multivariate logistic regression.Results: In the first part of the study,multivariate logistic regression analysis showed that smoking [17.98(3.51-92.25),P= 0.0005],abnormal blood glucose levels during hospitalization [6.20(1.13-34.03),P=0.0358],imaging showed that the maximum dilated inner diameter of the main pancreatic duct [8.76(1.10-69.76),P=0.0404],and the number of calcifications [0.16(0.05-0.47),P=0.0010] were risk or protective factors closely related to cancer of chronic pancreatitis.The AUC value of the internal validation model was0.8993(0.8100-0.9886).In the second part,multivariate logistic regression analysis showed that suspicious cells detected by EUS-FNA/FNB [36.67(5.30-253.77),P=0.0003]were independent risk factors associated with early pancreatic cancer.Is a risk factor associated with early development of pancreatic cancer.Conclusion: In the first part of the study,we found that smoking history,abnormal blood glucose level during hospitalization,and main pancreatic duct dilation are risk factors associated with cancer of chronic pancreatitis,suggesting that more attention should be paid to groups with risk factors in clinical work.The second part of the study found that suspicious cells detected by EUS-FNA/FNB were independent risk factors associated with early pancreatic cancer.It is expected to be further confirmed by a larger prospective multicenter study of this population in the future. |
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