The expanding cancer landscape in chronic pancreatitis

Chronic pancreatitis (CP) is driven by smoking, excessive alcohol use, and chronic inflammation - all known contributors to carcinogenesis. However, its association with malignancies beyond the pancreas remains underexplored. This study aimed to assess the frequency and spectrum of cancers in patients with CP.

A retrospective cohort study was conducted at Nottingham University Hospitals of patients diagnosed with CP between 1 January 2006 and 31 December 2014, identified through a multisource case ascertainment strategy. Cancer frequencies were assessed in patients residing within Greater Nottingham. Age-adjusted standardised incidence ratios (SIRs) were calculated using national cancer incidence data from England as the reference population. Statistical analyses were performed using R (version 4.3.3).

Of the 1003 CP patients identified, 678 resided in Greater Nottingham (median age at diagnosis 68 years (IQR 53-79); 66% male; 92% Caucasians. The median follow-up period was 7.3 years (IQR 2.8-11.6). Compared to the general population, patients with CP demonstrated significantly higher SIRs for upper respiratory tract (12.4; 95%CI 6.6-21.1; p < 0.0001), pancreatic (10.8; 95%CI 6.2-17.6; p < 0.0001), liver (8.8; 95%CI 2.4-22.6; p < 0.0001), lung (5.6; 95%CI 4.0-7.7; p < 0.0001), renal tract (4.8; 95%CI 2.7-7.9; p < 0.0001) oesophageal (4.8; 95%CI 1.8-10.4; p = 0.0001) and colorectal (2.5; 95%CI 1.4-4.2; p = 0.0009) cancers.

CP confers a markedly elevated risk of both pancreatic and extra-pancreatic cancers. These findings hypothesise that CP might be a high-risk state for malignancy that could warrant proactive, risk-based cancer surveillance in this vulnerable population.