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
ARTICLE HIGHLIGHTS
Research background

Pancreatic cancer (PC) is a major cause of cancer-related deaths worldwide. Its prognosis is poor, and curative-intent surgery remains the only approach for improving survival rates of PC patients. However, fewer than 20% of PC patients are eligible for surgery following diagnosis, due to local disease progression and metastasis. Therefore, avoiding risk factors as well as early diagnosis represent the most essential approaches for improving the survival of PC patients.

Research motivation

Previous studies have revealed several risk factors for PC including diabetes, smoking and chronic pancreatitis. Although chronic pancreatitis has been associated with PC, the relationship between acute pancreatitis (AP) and PC risk remains unclear due to inconsistent and contradictory results.

Research objectives

We explored the association between AP and PC risk using a meta-analysis of retrospective and prospective studies.

Research methods

We first searched PubMed, Web of Science, Cochrane, and EMBASE databases for original articles associating AP with PC using. We then calculated combined overall effect estimates (EEs) between AP and PC risk at a 95% confidence interval (CI), using a random-effects model and assessed heterogeneity using the I2 test. Thereafter, we examined the relationship between AP and PC using combined relative risk (RR), at 95%CI. Furthermore, we conducted publication bias and subgroup analyses, then analyzed sensitivities to explain the observed heterogeneity.

Research results

Eleven studies were eligible for inclusion in this meta-analysis, and resulted in a pooled EE 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 RR of 7.81 (95%CI: 5.00-12.19). Subgroup analyses, performed using different follow-up times, revealed pooled EEs of 23.47 (95%CI: 3.26-43.68), 9.82, (95%CI: 3.01-16.64), 2.47 (95%CI: 1.93-3.02), 1.69 (95%CI: 1.26-2.11) and 1.17 (95%CI: 0.78-1.57) for 1, 2, 5, 10 and > 10-year lag periods, respectively. Similar analyses targeting the type of research methods revealed EEs of 3.03 (95%CI: -1.02 to 7.08, P = 0.141) and 2.09 (95%CI: 1.22-2.97) for case-control sand cohort studies, respectively.

Research conclusions

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.

Research perspectives

Although AP might not be a direct cause for PC risk, its occurrence could be an indicators for PC. Future studies are expected to elucidate the association between AP and PC risk across different follow-up times, in order to improve early PC diagnosis.