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Rate of pancreatic cancer following a negative endoscopic ultrasound and associated factors

Lookup NU author(s): Professor John LeedsORCiD, Dr Manu Nayar, Professor Kofi Oppong

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Abstract

© 2022. Thieme. All rights reserved. Background Data are limited regarding pancreatic cancer diagnosed following a pancreaticobiliary endoscopic ultrasound (EUS) that does not diagnose pancreatic cancer. We have studied the frequency of, and factors associated with, post-EUS pancreatic cancer (PEPC) and 1-year mortality. Methods Between 2010 and 2017, patients with pancreatic cancer and a preceding pancreaticobiliary EUS were identified in a national cohort using Hospital Episode Statistics. Patients with a pancreaticobiliary EUS 6 18 months before a later pancreatic cancer diagnosis were the PEPC cases; controls were those with pancreatic cancer diagnosed within 6 months of pancreaticobiliary EUS. Multivariable logistic regression models examined the factors associated with PEPC and a Cox regression model examined factors associated with 1-year cumulative mortality. Results 9363 pancreatic cancer patients were studied; 93.5% identified as controls (men 53.2%; median age 68 [interquartile range (IQR) 61.75]); 6.5% as PEPC cases (men 58.2 %; median age 69 [IQR 61.77]). PEPC was associated with older age (. 75 years compared with < 65 years, odds ratio [OR] 1.42, 95 %CI 1.15.1.76), increasing co-morbidity (Charlson co-morbidity score > 5, OR 1.90, 95 %CI 1.49.2.43), chronic pancreatitis (OR 3.13, 95 %CI 2.50. 3.92), and diabetes mellitus (OR 1.58, 95 %CI 1.31.1.90). Metal biliary stents (OR 0.57, 95 %CI 0.38.0.86) and EUSFNA (OR 0.49, 95 %CI 0.41.0.58) were inversely associated with PEPC. PEPC was associated with a higher cumulative mortality at 1 year (hazard ratio 1.12, 95 %CI 1.02.1.24), with only 14% of PEPC patients (95%CI 12%.17 %) having a surgical resection, compared with 21% (95 %CI 20%.22%) of controls. Conclusions PEPC occurred in 6.5% of patients and was associated with chronic pancreatitis, older age, more comorbidities, and specifically diabetes mellitus. PEPC was associated with a worse prognosis and lower surgical resection rates.

Publication metadata

Author(s): King D, Kamran U, Dosanjh A, Coupland B, Mytton J, Leeds JS, Nayar M, Patel P, Oppong KW, Trudgill NJ

Publication type: Article

Publication status: Published

Journal: Endoscopy

Year: 2022

Volume: 54

Issue: 11

Pages: 1053-1061

Online publication date: 31/03/2022

Acceptance date: 10/02/2022

ISSN (print): 0013-726X

ISSN (electronic): 1438-8812

Publisher: Georg Thieme Verlag

URL: https://doi.org/10.1055/a-1784-1661

DOI: 10.1055/a-1784-1661

PubMed id: 35359019

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