Predictors of malignancy in chronic calcific pancreatitis with head mass

Table 1 Univariable analysis of demographic and clinical presentation of pancreatic lesions in chronic pancreatitis patients with inflammatory and malignant mass n (%)

Variables	Benign (n = 55)	Malignant (n = 28)	P value
Mean age (yr)	38.4	45	0.02
Gender			0.35
Male	39 (47)	17 (20.5)
Female	16 (19.3)	11 (13.3)
Etiology			0.05
Tropical	36 (43.4)	24 (28.9)
Alcoholic	19 (22.9)	4 (4.8)
Smoking	24 (28.9)	7 (8.4)	0.14
Symptoms
Jaundice	10 (12)	21 (25.3)	0.001
Abdominal pain (sudden worsening)	10 (12)	23 (27.7)	0.001
Persistent vomiting (GOO)	2 (2.4)	9 (10.8)	0.001
Significant wt. Loss	22 (26.5)	25 (13.1)	0.001
Steatorrhea	10 (12)	5 (6)	0.97
Diabetes (Recent onset/sudden worsening)	20 (24.1)	14 (16.9)	0.23

GOO: Gastric outlet obstruction.

Table 2 Surgical details in patients without fine needle aspiration cytology

Sl.no	Procedures	n = 40
1	Frey’s procedure	34
2	Frey’s + CDD	4
3	Whipple’s procedure	1
4	Bypass for liver metastasis	1

CDD: Choledochoduodenostomy.

Table 3 Relationship among ERCC1 genotypes, mRNA expression and clinical characteristics of gastric cancer

Variables	n	Mean ± SD	t-test	P value
Serum Bilirubin (mg%)			5.7	< 0.001
Benign	55	2.06 ± 2.76
Malignant	28	9.58 ± 6.67
CA19-9 (U/mL)			6.2	< 0.001
Benign	55	55.3 ± 126.2
Malignant	28	955 ± 751.9
MPD Diameter (mm)			3.5	0.001
Benign	55	7.7 ± 3.2
Malignant	28	12.7 ± 6.9
CBD Size (mm)			4.7	< 0.001
Benign	55	8.7 ± 5.1
Malignant	28	15.5 ± 6.6

MPD: Main pancreatic duct; CBD: Common bile duct.

Table 4 Sensitivity, specificity, positive predictive value and negative predictive value of the parameters

Parameters	Cut off value	Sensitivity	Specificity	PPV	NPV
CA 19-9	127 U/mL	85.7%	96.5%	92.3%	93.2%
T.Bilirubin	5.80 mg%	67.9%	89.1%	75.0%	83.1%
MPD	11.5 cms	46.4%	90.9%	72.2%	76.9%
CBD	14.5 cms	71.4%	83.6%	69.0%	85.2%

PPV: Positive predictive value; NPV: Negative predictive value; MPD: Main pancreatic duct; CBD: Common bile duct.

Table 5 Logistic regression analysis of factors associated with malignancy in patients with chronic calcific pancreatitis and head mass

Variables	β	SE	Wald	df	Sig.	Exp(β)
Jaundice	-0.768	2.112	0.132	1	0.716	0.464
Worsening pain	-1.109	1.128	0.967	1	0.325	0.330
GOO	-1.090	1.217	0.803	1	0.370	0.336
Wt loss	-1.755	1.226	2.049	1	0.152	0.173
Cause	-0.980	1.173	0.698	1	0.403	0.375
Total. Bil	-0.254	0.213	1.428	1	0.232	0.776
CA19.9	-0.005	0.002	4.085	1	0.043	0.995
MPD	-0.128	0.148	0.756	1	0.385	0.879
CBD	0.072	0.139	0.272	1	0.602	1.075
Constant	5.956	2.103	8.020	1	0.005	386.147

β: Regression coefficient; SE: Standard error; Wald: Wald statistics; df: Degree of freedom; Sig.: Significance; Exp (β): Exponential β (odds ratio); GOO: Gastric outlet obstruction; MPD: Main pancreatic duct; CBD: Common bile duct.

Table 6 Details of Readmission after surgery in patients with chronic calcific pancreatitis and head mass

Readmission	No. of patients
Post Frey’s	10
Pain	6
Acute pancreatitis	3
DKA	1
Post Whipple’s	4
Recurrence	1
Liver secondaries	2
Others (cardiac)	1
Post bypass
Celiac ganglion block	6

DKA: Diabetic keto-acidosis.