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Risk of Cancer in Patients With Autoimmune Pancreatitis

Shiokawa, Masahiro MD1; Kodama, Yuzo MD, PhD1; Yoshimura, Kenichi MD, PhD2; Kawanami, Chiharu MD3; Mimura, Jun MD4; Yamashita, Yukitaka MD, PhD5; Asada, Masanori MD, PhD6; Kikuyama, Masataka MD, PhD7; Okabe, Yoshihiro MD, PhD8; Inokuma, Tetsuro MD, PhD9; Ohana, Masaya MD, PhD10; Kokuryu, Hiroyuki MD11; Takeda, Kazuo MD, PhD12; Tsuji, Yoshihisa MD, PhD13; Minami, Ryuki MD1; Sakuma, Yojiro MD1; Kuriyama, Katsutoshi MD1; Ota, Yuji MD1; Tanabe, Wataru MD1; Maruno, Takahisa MD1; Kurita, Akira MD1; Sawai, Yugo MD1; Uza, Norimitsu MD, PhD1; Watanabe, Tomohiro MD, PhD1; Haga, Hironori MD, PhD14; Chiba, Tsutomu MD, PhD1

American Journal of Gastroenterology: April 2013 - Volume 108 - Issue 4 - p 610–617
doi: 10.1038/ajg.2012.465
Pancreas and Biliary Tract
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OBJECTIVES: Although simultaneous occurrences of autoimmune pancreatitis (AIP) and cancer are occasionally observed, it remains largely unknown whether cancer and AIP occur independently or these disorders are interrelated. The aim of this study was to examine the relationship between AIP and cancer.

METHODS: We conducted a multicenter, retrospective cohort study. One hundred and eight patients who met the Asian diagnostic criteria for AIP were included in the study. We calculated the proportion, standardized incidence ratio (SIR), relative risk, and time course of cancer development in patients with AIP. We also analyzed the clinicopathological characteristics of AIP patients with cancer in comparison with those without cancer.

RESULTS: Of the 108 AIP patients, 18 cancers were found in 15 patients (13.9%) during the median follow-up period of 3.3 years. The SIR of cancer was 2.7 (95% confidence interval (CI) 1.4–3.9), which was stratified into the first year (6.1 (95% CI 2.3–9.9)) and subsequent years (1.5 (95% CI 0.3–2.8)) after AIP diagnosis. Relative risk of cancer among AIP patients at the time of AIP diagnosis was 4.9 (95% CI 1.7–14.9). In six of eight patients whose cancer lesions could be assessed before corticosteroid therapy for AIP, abundant IgG4-positive plasma cell infiltration was observed in the cancer stroma. These six patients experienced no AIP relapse after successful cancer treatment.

CONCLUSIONS: Patients with AIP are at high risk of having various cancers. The highest risk for cancer in the first year after AIP diagnosis and absence of AIP relapse after successful treatment of the coexisting cancers suggest that AIP may develop as a paraneoplastic syndrome in some patients.

1 Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan

2 Translational Research Center, Kyoto University Hospital, Kyoto, Japan

3 Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, Otsu, Japan

4 Department of Gastroenterology and Hepatology, Nishikobe Medical Center, Kobe, Japan

5 Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

6 Department of Digestive Disease Center, Kitano Hospital, Osaka, Japan

7 Department of Gastroenterology and Hepatology, Shizuoka General Hospital, Shizuoka, Japan

8 Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan

9 Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan

10 Department of Gastroenterology and Hepatology, Tenri Hospital, Tenri, Japan

11 Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan

12 Kyoto Industrial Health Association, Kyoto, Japan

13 Division of Radiology/Gastroenterology and Hepatology, Mayo clinic, Rochester, Minnesota, USA

14 Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan

Correspondence: Yuzo Kodama, MD, PhD, Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. E-mail: kodamayu@kuhp.kyoto-u.ac.jp

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A717

Received 23 April 2012; accepted 18 December 2012

published online 15 January 2013

© The American College of Gastroenterology 2013. All Rights Reserved.
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