Maintenance steroid therapy is associated with decreased risk of malignancy and better prognosis of patients with autoimmune pancreatitis : A multicenter cohort study in Japan
Copyright © 2024 IAP and EPC. Published by Elsevier B.V. All rights reserved..
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 insufficiency, diabetes mellitus, and osteoporosis.
RESULTS: The SIR for all malignancies was increased (1.21 [95 % confidence 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al. - 24(2024), 3 vom: 18. Apr., Seite 335-342 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Takikawa, Tetsuya [VerfasserIn] |
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| Links: |
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| Themen: |
Autoimmune pancreatitis |
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| Anmerkungen: |
Date Completed 19.04.2024 Date Revised 19.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.pan.2024.01.008 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368259951 |
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| 100 | 1 | |a Takikawa, Tetsuya |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Maintenance steroid therapy is associated with decreased risk of malignancy and better prognosis of patients with autoimmune pancreatitis |b A multicenter cohort study in Japan |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 19.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 IAP and EPC. Published by Elsevier B.V. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 insufficiency, diabetes mellitus, and osteoporosis | ||
| 520 | |a RESULTS: The SIR for all malignancies was increased (1.21 [95 % confidence 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Autoimmune pancreatitis | |
| 650 | 4 | |a IgG4-related disease | |
| 650 | 4 | |a Osteoporosis | |
| 650 | 4 | |a Pancreatic cancer | |
| 650 | 4 | |a Pancreatic exocrine insufficiency | |
| 650 | 7 | |a Steroids |2 NLM | |
| 700 | 1 | |a Kikuta, Kazuhiro |e verfasserin |4 aut | |
| 700 | 1 | |a Sano, Takanori |e verfasserin |4 aut | |
| 700 | 1 | |a Ikeura, Tsukasa |e verfasserin |4 aut | |
| 700 | 1 | |a Fujimori, Nao |e verfasserin |4 aut | |
| 700 | 1 | |a Umemura, Takeji |e verfasserin |4 aut | |
| 700 | 1 | |a Naitoh, Itaru |e verfasserin |4 aut | |
| 700 | 1 | |a Nakase, Hiroshi |e verfasserin |4 aut | |
| 700 | 1 | |a Isayama, Hiroyuki |e verfasserin |4 aut | |
| 700 | 1 | |a Kanno, Atsushi |e verfasserin |4 aut | |
| 700 | 1 | |a Kamata, Ken |e verfasserin |4 aut | |
| 700 | 1 | |a Kodama, Yuzo |e verfasserin |4 aut | |
| 700 | 1 | |a Inoue, Dai |e verfasserin |4 aut | |
| 700 | 1 | |a Ido, Akio |e verfasserin |4 aut | |
| 700 | 1 | |a Ueki, Toshiharu |e verfasserin |4 aut | |
| 700 | 1 | |a Seno, Hiroshi |e verfasserin |4 aut | |
| 700 | 1 | |a Yasuda, Hiroaki |e verfasserin |4 aut | |
| 700 | 1 | |a Iwasaki, Eisuke |e verfasserin |4 aut | |
| 700 | 1 | |a Nishino, Takayoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Kubota, Kensuke |e verfasserin |4 aut | |
| 700 | 1 | |a Arizumi, Toshihiko |e verfasserin |4 aut | |
| 700 | 1 | |a Tanaka, Atsushi |e verfasserin |4 aut | |
| 700 | 1 | |a Uchida, Kazushige |e verfasserin |4 aut | |
| 700 | 1 | |a Matsumoto, Ryotaro |e verfasserin |4 aut | |
| 700 | 1 | |a Hamada, Shin |e verfasserin |4 aut | |
| 700 | 1 | |a Nakamura, Seiji |e verfasserin |4 aut | |
| 700 | 1 | |a Okazaki, Kazuichi |e verfasserin |4 aut | |
| 700 | 1 | |a Takeyama, Yoshifumi |e verfasserin |4 aut | |
| 700 | 1 | |a Masamune, Atsushi |e verfasserin |4 aut | |
| 700 | 0 | |a Japan Pancreatitis Study Group for AIP |e verfasserin |4 aut | |
| 700 | 1 | |a Nakayama, Shinji |e investigator |4 oth | |
| 700 | 1 | |a Nakamura, Akira |e investigator |4 oth | |
| 700 | 1 | |a Masaki, Yoshiharu |e investigator |4 oth | |
| 700 | 1 | |a Ushio, Mako |e investigator |4 oth | |
| 700 | 1 | |a Watanabe, Tomohiro |e investigator |4 oth | |
| 700 | 1 | |a Tsujimae, Masahiro |e investigator |4 oth | |
| 700 | 1 | |a Tanoue, Shiro |e investigator |4 oth | |
| 700 | 1 | |a Maruo, Toru |e investigator |4 oth | |
| 700 | 1 | |a Shiokawa, Masahiro |e investigator |4 oth | |
| 700 | 1 | |a Yamane, Satoki |e investigator |4 oth | |
| 700 | 1 | |a Kayashima, Atsuto |e investigator |4 oth | |
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