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Risk of Pancreatic Adenocarcinoma in Patients With Hereditary Pancreatitis

A National Exhaustive Series

Rebours, Vinciane, M.D.1; Boutron-Ruault, Marie-Christine, M.D., Ph.D.2; Schnee, Matthieu, M.D.3; Férec, Claude, M.D., Ph.D.4; Maire, Frédérique, M.D.1; Hammel, Pascal, Ph.D., M.D.1; Ruszniewski, Philippe, M.D.1; Lévy, Philippe, M.D.1

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 111–119

BACKGROUND AND AIMS An increased risk of pancreatic adenocarcinoma (PA) in patients with hereditary pancreatitis (HP) was previously demonstrated in two multinational studies. The PA frequency in this setting is however unknown due to lack of exhaustive case collection. The aims of this study were to evaluate the standardized incidence ratio (SIR) of PA in an exhaustive national series of patients with HP and to search for risk factors.

METHODS All French genetic laboratories (response rate 100%), pediatricians, and gastroenterologists (response rate 84%) were contacted. Inclusion criteria: mutation in the PRSS1 gene or recurrent, acute, or chronic pancreatitis, with no precipitating factors in two first-degree relatives or ≥3 second-degree relatives in ≥2 generations. Diagnosis of PA was based on histological records.

RESULTS Seventy-eight families and 200 patients were included (181 alive, 6,673 person-years, median number of generations 3, men 53%, alcoholism 5%, and smoking 34%). PRSS1 mutations were searched for in 96% of the patients and were detected in 68% (maternal inheritance 54%, R122H 78%, N29I 12%, and others 10%). Ten PA were diagnosed (median age 55 yr). SIR of PA for the whole population, men, and women were 87 (95% CI 42–113), 69 (25–150), and 142 (38–225), respectively, with no influence of genetic mutation. At ages 50 and 75 yr, the cumulated risk of PA was 11% and 49% for men and 8% and 55% for women, respectively. Smoking and diabetes mellitus were the main associated risk factors.

CONCLUSION Patients with HP have a marked relative and absolute increased risk of PA as compared to the general population, especially in smokers. There is no correlation with the type of PRSS1 mutation.

1Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie - Pancréatologie, Hôpital Beaujon, AP-HP, Université Denis Diderot-Paris VII, Clichy, France; 2Unité Nutrition – Hormones et Cancer E3N, Inserm, Institut Gustave Roussy, Villejuif, France; 3Service d'Hépato-Gastro-Entérologie, Centre Hospitalier Départemental, La Roche sur Yon, France; and 4Inserm-0115, Génétique Moléculaire et Génétique Epidémiologique, Etablissement Français du Sang-Bretagne, Université de Bretagne Occidentale, Centre Hospitalier Universitaire, Brest, France

Reprint requests and correspondence: Philippe Lévy, Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, APHP, Hôpital Beaujon, 92118 Clichy Cedex, France.

Received January 15, 2007; Accepted August 27, 2007.

CONFLICT OF INTERESTGuarantor of the article: Philippe Lévy

Specific author contributions: Planning of the study: Vinciane Rebours, Marie-Christine Boutron-Ruault, Matthieu Schnée, Claude Férec, Philippe Ruszniewski, Philippe Lévy. Conducting the study: Vinciane Rebours, Marie-Christine Boutron-Ruault, Matthieu Schnée, Claude Férec, Philippe Ruszniewski, Philippe Lévy, Pascal Hammel, Frédérique Maire. Drafting the manuscript: all the authors. All authors have approved the final draft of the manuscript. Written signed approval from all the authors can be provided on request.

Financial support: Vinciane Rebours was supported by a grant from Solvay Pharma Pharmaceuticals Inc.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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