Pancreas最新文献

Aim: This study aimed to investigate the relationship between non-alcoholic fatty pancreas disease (NAFPD) and metabolic dysfunction-associated steatotic liver disease (MASLD), and to evaluate the effects of pancreatic steatosis on clinical and laboratory parameters in patients aged 40-49 years. The secondary aim was to identify independent predictors of pancreatic steatosis and discuss their clinical relevance for early detection and prevention.

Methods: This retrospective single-center study included 132 patients aged 40-49 years who underwent abdominal magnetic resonance imaging (MRI). Pancreatic and hepatic fat fractions were measured using a chemical shift-based MRI technique. Demographic data, comorbidities, and laboratory parameters were analyzed. Patients with a history of alcohol intake, pancreatitis, or incomplete data were excluded.

Results: Pancreatic steatosis was present in 35.6% of participants. Patients with pancreatic steatosis had significantly higher rates of diabetes mellitus (59.6% vs. 21.2%), obesity (61.7% vs. 14.1%), hypertension (38.3% vs. 17.6%), and hyperlipidemia (44.7% vs. 20%) (all P<0.01). Pancreatic steatosis was strongly associated with hepatic steatosis (80.9% vs. 11.8%, P<0.001). Fasting glucose, HbA1c, HOMA-IR, and triglycerides were higher, whereas HDL and amylase were lower in the steatosis group. In multivariate logistic regression, diabetes mellitus (OR 8.06, 95% CI: 1.15-56.76, P=0.036) and HOMA-IR (OR 1.54, 95% CI: 1.19-1.99, P=0.001) were identified as independent predictors of pancreatic steatosis. Among patients with pancreatic steatosis, 80.9% also had hepatic steatosis, demonstrating a significant association between pancreatic and hepatic fat accumulation.

Conclusion: A significant association was found between pancreatic steatosis and metabolic risk factors such as diabetes, obesity, insulin resistance, and MASLD. MRI-based quantification provided accurate detection, supporting its value as the most reliable imaging modality for assessing pancreatic fat. Lifestyle interventions such as weight loss and physical activity may help mitigate pancreatic steatosis and related metabolic consequences. Further studies are needed to clarify causality and underlying pathways, such as lipotoxicity, inflammation, and β-cell dysfunction.

Background: Mucinous cyst-associated pancreatic cancer (CA-PC) outcomes are varied. This study compares the presentation, management, and outcomes of CA-PC with classic pancreatic ductal adenocarcinoma (PDAC) using a national dataset.

Methods: We queried the National Cancer Database (NCDB) from 2006-2019 for patients with AJCC Stage I-IV CA-PC and PDAC using histologic codes. Clinicopathologic characteristics and outcomes were analyzed, and overall survival (OS) was compared using Kaplan-Meier and Cox proportional hazard models.

Results: Among 239,563 patients, 8,260 (4%) had CA-PC, while 231,303 (97%) had PDAC. CA-PC was diagnosed at earlier stages (Stage II-IV: 66% vs. 76%, P<0.001), with more patients undergoing pancreatectomy (34% vs. 24%, P<0.001). CA-PC patients more frequently had upfront surgery (91.% vs. 76%, P<0.001) but less chemotherapy (55% vs. 75%, P<0.001) and radiation (23% vs. 33%, P<0.001). Median OS after resection was longer for CA-PC (43.2 vs. 22.9 months, P<0.001). CA-PC was associated with improved survival in stages I (HR 0.49) and II (HR 0.73), but not in stage III (HR 1.07).

Discussion: CA-PC has a better prognosis than PDAC in early stages but not in advanced disease, offering important insights for therapeutic strategies.

Background: Acute pancreatitis (AP) is a critical inflammatory condition associated with significant morbidity and mortality. Calcium ions (Ca2+) have been implicated in the pathophysiology of AP, with potential predictive value for disease severity and patient outcomes, including hospital length of stay (LOS).

Objective: The study aimed to investigate the relationship between serum calcium levels and LOS in patients with AP, considering the non-linear trends and potential threshold effects of Ca2+.

Methods: We conducted a retrospective cohort study including 717 patients with AP admitted to the gastroenterology departments of Ningbo Second Hospital from July 2020 to June 2023. Data on demographic characteristics, medical history, and laboratory parameters were collected. The relationship between Ca2+ levels and LOS was analyzed using univariate and multivariate regression models, with adjustments for potential confounders. Non-linear trends were explored using a Generalized Additive Model (GAM) and piecewise linear regression.

Results: The study revealed a significant non-linear relationship between Ca2+ levels and LOS, with distinct inflection points at Ca2+ concentrations of 1.7 mmol/L and 2.5 mmol/L. Below 1.7 mmol/L, Ca2+ showed no significant association with LOS, whereas between 1.7 and 2.5 mmol/L, a significant negative effect was observed. Above 2.5 mmol/L, a significant positive effect emerged. The study also identified significant effect size variations across different subgroups, including sex, age, BMI, and comorbidities.

Objective: Leveraging geospatial data and SDOH (social determinants of health) indices may enhance understanding of the interactions between geographic and social factors that facilitate early cancer diagnosis. We sought to characterize associations between travel distance, time, and early-stage pancreatic ductal adenocarcinoma (PDAC) diagnosis.

Methods: This was a retrospective study of PDAC patients at an urban academic medical center between 1/1/12-2/31/22. We geocoded patients to census tract to calculate car travel distance and time. For residents within city limits, we calculated public transit time. Primary outcome was stage I diagnosis. Logistic regression was used for travel measures, and multivariable analyses adjusted for age, diagnosis year, and insurance. Sensitivity analyses were done using Area Deprivation Index and SDOH Atlas.

Results: We identified 694 PDAC patients with 146 (23.2%) having stage I diagnosis. Residing >25 miles and car travel time >45 minutes were associated with early diagnosis (OR 2.35, 95% CI [1.41, 3.98], OR 2.49, 95% CI [1.53, 4.14] respectively). On sensitivity analyses, these associations persisted in low to moderate deprivation neighborhoods. Among city residents, there was no association between travel measures and early diagnosis.

Conclusions: Patients in less socioeconomically deprived neighborhoods are diagnosed at earlier stage despite traveling longer distances and times.

Objectives: Acute pancreatitis (AP) is associated with significant morbidity and mortality. While most patients fully recover following the acute phase of illness, some develop long-term complications. The objective of this study was to estimate short- and long-term costs among adults hospitalized with AP in US clinical practice, overall and within subgroups defined by AP cause.

Methods: A retrospective cohort design and healthcare claims database were employed. The study population comprised adults hospitalized for AP (first admission = index admission), and was considered overall as well as by AP cause (alcohol-induced, biliary-induced, drug-induced, cause unknown, multiple causes). AP-related healthcare utilization/expenditures were evaluated during the short-term episode (index admission + encounters separated by <30 days) and long-term follow-up period (1 year from end of episode).

Results: Among the 5,051 hospitalized AP patients in the study population, 7% (range by AP cause: 6-8%) had necrosis, 22% (19-26%) had organ failure, 12% (6-16%) had sepsis, and 14% (9-19%) had systemic inflammatory response syndrome. During the long-term follow-up period, rates of recurrent AP and chronic pancreatitis were 14 (8-29) and 15 (10-25), respectively, per 100 person-years. Mean AP-related expenditures were $31,119 ($22,963-$37,733) during the short-term episode, and $12,470 ($9,614-$20,657) during the long-term follow-up period; total expenditures averaged $43,598 ($32,577-$58,390) per patient.

Conclusions: The cost of AP requiring hospitalization is high, for the treatment of both acute disease as well as associated long-term complications, which underscores the potential economic benefits from the prevention of this condition.

Objectives: Diabetes mellitus and chronic pancreatitis are established risk factors for pancreatic ductal adenocarcinoma (PDAC). The co-occurence of exocrine and endocrine pancreatic dysfunction may increase the risk of progression to PDAC and could play a role in early detection. We sought to explore this hypothesis by comparing PDAC risk among patients with diabetes mellitus (DM) and low fecal elastase (FE) in a real-world cohort of patients.

Materials and methods: A retrospective cohort study was conducted using the TriNetX research network including adults with continuous follow-up from 2016 to 2023. The cohort was stratified into four groups based on the prescene or absence of DM, and normal FE (>200 µg/g) or low FE (<200 µg/g). The four groups included: (1) low FE and DM, (2) low FE without DM, (3) normal FE and DM, (4) normal FE without DM. Propensity score matching was performed to balance covariates including age, sex, race, comorbidities to allow for a six-way comparison of PDAC risk between groups. Time-to-event analyses were conducted with Kaplan-Meier curves and Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the primary outcome of PDAC incidence.

Results: Of the study cohort, 29,207 had fecal elastase levels. Low FE (<200 µg/g) was observed in 33% (n=9,585) of these patients. After six-way comparisons, we observed a higher PDAC risk among individuals with both DM and low FE compared to other groups. The highest PDAC risk was observed in patients with both a low FE (<200 µg/g) and DM compared to those with a normal FE and without a history of DM (HR 3.68; 95% CI, 2.07-6.53; P<0.001). Sensitivity analysis using a stricter fecal elastase cutoff of <100 µg/g showed a similar finding, with the highest hazard ratio for PDAC among patients with both DM and very low FE levels [HR 3.07, 95% CI, 1.37-6.91; P=0.004].

Conclusions: The coexistence of low fecal elastase and DM amplifies the risk of pancreatic ductal adenocarcinoma in our cohort of patients. These results suggest that fecal elastase values may be used to enrich the diabetic population for future PDAC risk stratification, though more studies are needed to validate these findings.

Objectives: To explore the correlation between the stenosis of celiac axis (CA) and superior mesenteric artery (SMA) and complications after pancreatoduodenectomy (PD).

Materials and methods: This retrospective study analyzed patients undergoing PD at the Pancreas Center of our hospital between January 2021 and December 2023. The stenosis of CA and SMA was measured using preoperative arterial phase imaging of contrast-enhanced multi-detector computed tomography (MDCT). CA and SMA stenosis were defined as a stenosis rate ≥50%. The correlation between celiac axis stenosis (CAS), SMA stenosis, and postoperative complications was systematically evaluated. Univariate and multivariate logistic regression analyses were performed to identify risk factors for major complications after PD.

Results: A total of 900 patients were enrolled in this study. CAS was identified in 70 (7.8%) patients, and SMA stenosis was identified in 43 (4.8%) patients. CAS was significantly associated with postoperative pancreatic fistula (POPF) (P=0.044), postpancreatectomy hemorrhage (PPH) (P=0.003), delayed gastric emptying (DGE) (P=0.013) and biliary fistula (BF) (P=0.014). Multivariate analysis revealed that CAS was an independent risk factor for POPF (OR 2.632, 95% CI 1.409, 4.917, P=0.002) and PPH (OR 3.745, 95% CI 1.699, 8.257, P=0.001). No significant correlation was found between SMA stenosis and complications after PD.

Conclusions: CAS identified by preoperative contrast-enhanced MDCT was associated with the risk of complications after PD. Radiologists and surgeons should evaluate the condition of CAS in patients before PD.

Background: Paralytic ileus is a frequent complication of acute pancreatitis (AP), contributing to increased morbidity, nutritional compromise, and risk of infection. Despite its clinical relevance, data on its incidence, predictors, management, and outcomes in AP remain limited.

Methods: We conducted a retrospective study of 426 adult patients admitted with AP over a 3-year period at a tertiary-care center. The primary outcome was paralytic ileus; secondary outcomes included infected necrosis, intervention, and mortality. Multivariate logistic regression identified independent predictors expressed as adjusted odds ratio (aOR).

Results: Paralytic ileus occurred in 167/426 (39.2%) patients. Patients with ileus were more frequently male, obese, and had higher rates of SIRS compared to those without ileus. They also exhibited significantly higher leukocyte counts, neutrophil-lymphocyte ratio (NLR), serum creatinine, and lower serum albumin and sodium levels. In multivariate analysis, obesity (aOR: 2.329), NLR (aOR: 1.131), serum albumin (aOR: 0.342), and serum sodium (aOR: 0.802) were identified as independent predictors. An NLR of 9.5 had a sensitivity of 82.6% and a specificity of 76.1% for predicting paralytic ileus. Conservative management resolved ileus in 85% of cases, 6% responded to neostigmine, while 9% with unresolved ileus succumbed to multiorgan failure. Paralytic ileus was independently associated with increased risk of infected necrosis (aOR: 3.62), intervention (aOR: 4.43), and mortality (aOR: 4.71).

Conclusion: Paralytic ileus affects a significant proportion of patients with moderate to severe AP and is a marker of local and systemic complications. Paralytic ileus was an independent predictor of infected necrosis, intervention, and mortality, underscoring its prognostic relevance.