Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4416-4430
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4416
Meta-analysis reveals an association between acute pancreatitis and the risk of pancreatic cancer
Jie Liu, Ying Wang, Yue Yu
Jie Liu, Yue Yu, Department of Gastroenterology, Affiliated Provincial Hospital, Anhui Medical University, Hefei 230001, Anhui Province, China
Ying Wang, Endoscopy Center Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230036, Anhui Province, China
Author contributions: Yu Y and Liu J contributed to planning the study; Wang Y collected and assembled the data; Liu J and Wang Y contributed to collecting and interpreting the data; and Liu J contributed to drafting the manuscript; Liu J and Wang Y contributed equally to this work; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 31870993.
Conflict-of-interest statement: All authors have no conflict(s) of interest to declare in relation to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised in accordance with this checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yue Yu, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, Affiliated Provincial Hospital, Anhui Medical University, No. 17 Lujiang Road, Hefei 230001, Anhui Province, China. yuyuemd@163.com
Received: May 6, 2020
Peer-review started: May 6, 2020
First decision: June 18, 2020
Revised: June 26, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: October 6, 2020
Processing time: 144 Days and 17.4 Hours
Abstract
BACKGROUND

Chronic pancreatitis is associated with pancreatic cancer (PC), although the relationship between acute pancreatitis (AP) and the risk of PC remains unclear due to inconsistent and contradictory results.

AIM

To conduct a meta-analysis of retrospective and prospective studies to explore the association between AP and PC risk.

METHODS

We first searched original articles on the association of AP with PC using PubMed, Web of Science, Cochrane, and EMBASE databases. Then we calculated the combined overall effect estimates (EEs) between AP and PC risk at a 95% confidence interval (CI) deploying a random-effects model, and assessed heterogeneity using the I2 test. The combined relative risk with 95%CI was performed to examine the relationship between AP and PC. Publication bias and subgroup analyses were also conducted. Furthermore, we performed sensitivity analysis to explain this heterogeneity.

RESULTS

Eleven studies were eligible for inclusion standards in this meta-analysis, resulting in pooled EEs of 2.07 (95%CI: 1.36-2.78) for AP and PC risk. Additionally, five prospective cohort studies reported 103961 patients in the AP group, relative to 1442158 subjects in the control group, with a pooled relative risk of 7.81 (95%CI: 5.00-12.19). We also performed subgroup analyses using different follow-up times and type of research methods (case-control or cohort). Results from analyses of different follow-up times revealed the following pooled effect values: 1-year lag period (EEs = 23.47, 95%CI: 3.26-43.68), 2-year lag period (EEs = 9.82, 95%CI: 3.01-16.64), 5-year lag period (EEs = 2.47, 95%CI: 1.93-3.02), 10-year lag period (EEs = 1.69, 95%CI: 1.26-2.11), and > 10-year lag period (EEs = 1.17, 95%CI: 0.78-1.57). With regards to the methods, the case-control studies recorded EEs = 3.03 (95%CI: -1.02 to 7.08), whereas cohort studies had EEs = 2.09 (95%CI: 1.22-2.97) pooled effect values.

CONCLUSION

Overall, our findings indicated an association between AP and PC risk. Based on subgroup analyses, AP is unlikely to be a causal factor for PC.

Keywords: Acute pancreatitis; Pancreatic cancer; Meta-analysis

Core Tip: It is well-known that acute pancreatitis (AP) might be the earliest clinical presentation of pancreatic cancer (PC). However, the relationship between AP and the risk of PC remains unclear due to inconsistent and contradictory results. In the current study, we conducted a meta-analysis of retrospective and prospective studies to explore the association between AP and PC risk. Our findings suggest that AP might not be a direct cause of PC risk, but its occurrence could be an indicator of PC. Future studies are expected to analyze the association between AP and PC risk across different follow-up times in order to improve early PC identification. Overall, more focus should be directed towards improving PC prevention approaches, of which a key element is early screening for patients at the onset of AP.