Maintenance steroid therapy is associated with decreased risk of malignancy and better prognosis of patients with autoimmune pancreatitis: A multicenter cohort study in Japan

被引：8

作者：

Takikawa, Tetsuya ^{[1
]}

Kikuta, Kazuhiro ^{[1
]}

Sano, Takanori ^{[1
]}

Ikeura, Tsukasa ^{[2
]}

Fujimori, Nao ^{[3
]}

Umemura, Takeji ^{[4
]}

Naitoh, Itaru ^{[5
]}

Nakase, Hiroshi ^{[6
]}

Isayama, Hiroyuki ^{[7
]}

Kanno, Atsushi ^{[8
]}

Kamata, Ken ^{[9
]}

Kodama, Yuzo ^{[10
]}

Inoue, Dai ^{[11
]}

Ido, Akio ^{[12
]}

Ueki, Toshiharu ^{[13
]}

Seno, Hiroshi ^{[14
]}

Yasuda, Hiroaki ^{[15
]}

Iwasaki, Eisuke ^{[16
]}

Nishino, Takayoshi ^{[17
]}

Kubota, Kensuke ^{[18
]}

Arizumi, Toshihiko ^{[19
]}

Tanaka, Atsushi ^{[19
]}

Uchida, Kazushige ^{[20
]}

Matsumoto, Ryotaro ^{[1
]}

Hamada, Shin ^{[1
]}

Nakamura, Seiji ^{[21
]}

Okazaki, Kazuichi ^{[22
]}

Takeyama, Yoshifumi ^{[23
]}

Masamune, Atsushi ^{[1
]}

机构：

[1] Tohoku Univ, Div Gastroenterol, Grad Sch Med, 1-1 Seiryomachi,Aoba Ku, Sendai 9808574, Japan

[2] Kansai Med Univ, Dept Internal Med 3, Osaka, Japan

[3] Kyushu Univ, Grad Sch Med Sci, Dept Med & Bioregulatory Sci, Fukuoka, Japan

[4] Shinshu Univ, Sch Med, Dept Med, Div Gastroenterol & Hepatol, Matsumoto, Japan

[5] Nagoya City Univ, Grad Sch Med Sci, Dept Gastroenterol & Metab, Nagoya, Japan

[6] Sapporo Med Univ, Sch Med, Dept Gastroenterol & Hepatol, Sapporo, Japan

[7] Juntendo Univ, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[8] Jichi Med Univ, Dept Med, Div Gastroenterol, Shimotsuke, Tochigi, Japan

[9] Kindai Univ, Fac Med, Dept Gastroenterol & Hepatol, Osaka, Japan

[10] Kobe Univ, Grad Sch Med, Dept Internal Med, Div Gastroenterol, Kobe, Japan

[11] Kanazawa Univ, Grad Sch Med Sci, Dept Radiol, Kanazawa, Japan

[12] Kagoshima Univ, Grad Sch Med & Dent Sci, Digest & Lifestyle Dis, Kagoshima, Japan

[13] Fukuoka Univ, Chikushi Hosp, Dept Gastroenterol, Fukuoka, Japan

[14] Kyoto Univ, Grad Sch Med, Dept Gastroenterol & Hepatol, Kyoto, Japan

[15] Kyoto Prefectural Univ Med, Grad Sch Med Sci, Dept Mol Gastroenterol & Hepatol, Kyoto, Japan

[16] Keio Univ, Sch Med, Dept Internal Med, Div Gastroenterol & Hepatol, Tokyo, Japan

[17] Tokyo Womens Med Univ, Yachiyo Med Ctr, Dept Gastroenterol, Yachiyo, Japan

[18] Yokohama City Univ, Grad Sch Med, Div Gastroenterol, Yokohama, Japan

[19] Teikyo Univ, Sch Med, Dept Med, Tokyo, Japan

[20] Kochi Univ, Kochi Med Sch, Dept Gastroenterol & Hepatol, Kochi, Japan

[21] Kyushu Univ, Fac Dent Sci, Fukuoka, Japan

[22] Kansai Med Univ, Kori Hosp, Dept Internal Med, Neyagawa, Japan

[23] Kindai Univ, Fac Med, Dept Surg, Osaka, Japan

来源：

PANCREATOLOGY | 2024年 / 24卷 / 03期

关键词：

Autoimmune pancreatitis; IgG4-related disease; Osteoporosis; Pancreatic cancer; Pancreatic exocrine insufficiency; CLINICAL-DIAGNOSTIC-CRITERIA; CANCER; MORTALITY; RELAPSE; IMPACT;

D O I：

10.1016/j.pan.2024.01.008

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background/objectives: The association between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) remains controversial. This study aimed to clarify the long-term prognosis and risk of malignancies in AIP patients in Japan. Methods: We conducted a multicenter retrospective cohort study on 1364 patients with type 1 AIP from 20 institutions in Japan. We calculated the standardized incidence ratio (SIR) for malignancies compared to that in the general population. We analyzed factors associated with overall survival, pancreatic exocrine insuf ficiency, diabetes mellitus, and osteoporosis. Results: The SIR for all malignancies was increased (1.21 [95 % con fidence interval: 1.05-1.41]) in patients with AIP. Among all malignancies, the SIR was highest for PC (3.22 [1.99-5.13]) and increased within 2 years and after 5 years of AIP diagnosis. Steroid use for >= 6 months and >= 50 months increased the risk of subsequent development of diabetes mellitus and osteoporosis, respectively. Age >= 65 years at AIP diagnosis (hazard ratio [HR] = 3.73) and the development of malignancies (HR = 2.63), including PC (HR = 7.81), were associated with a poor prognosis, whereas maintenance steroid therapy was associated with a better prognosis (HR = 0.35) in the multivariate analysis. Maintenance steroid therapy was associated with a better prognosis even after propensity score matching for age and sex. Conclusions: Patients with AIP are at increased risk of developing malignancy, especially PC. PC is a critical prognostic factor for patients with AIP. Although maintenance steroid therapy negatively impacts diabetes mellitus and osteoporosis, it is associated with decreased cancer risk and improved overall survival. (c) 2024 IAP and EPC. Published by Elsevier B.V. All rights reserved.

引用

页码：335 / 342

页数：8

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