Pancreas最新文献

Objectives: The diagnosis of spontaneous bacterial peritonitis relies on polymorphonuclear (PMN) cell counts (>250/mm3) in cirrhotic ascites. However, ascites in pancreatic ductal adenocarcinoma (PDAC) develop through mixed mechanisms, presenting different profiles compared to those of cirrhotic ascites. This study aimed to investigate the characteristics of PDAC-associated ascites and propose redefined criteria for bacterial peritonitis diagnosis in patients with PDAC.

Methods: This retrospective study was conducted at three tertiary medical centers in Korea. The etiology (peritoneal carcinomatosis, portal hypertension, or mixed etiology) and characteristics of PDAC-associated ascites of the exploration cohort (n=493) were analyzed. Diagnostic criteria for bacterial peritonitis were then derived from patients with elevated PMN cell counts (>250/mm3, n=183) in ascites. Subsequently, these criteria were validated in an external cohort (n=614).

Results: Peritoneal carcinomatosis and portal hypertension showed similar proportions as ascites etiologies. Median PMN cell counts and proportions were higher in peritoneal carcinomatosis (106/mm3, 13%) than in portal hypertension (15/mm3, 7%; P<0.001) and mixed etiology (38/mm3, 9%; P<0.05). In the derivation analysis, PMN cell proportion was the sole statistically significant variable for bacterial peritonitis diagnosis, with an optimal cut-off value of >35.5%. The redefined diagnostic criteria for bacterial peritonitis (PMN cell proportion >35% with counts >250/mm3) increased the specificity from 85% to 92% (RR: 1.08, 95% CI 1.04-1.13, P<0.001) in external validation, with minimal compromise in the sensitivity.

Conclusions: PDAC-associated ascites exhibited distinct characteristics according to their etiology. Redefined diagnostic criteria could aid in a more specific diagnosis of bacterial peritonitis in patients with PDAC.

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.

Objectives: Sarcopenia is characterized by skeletal mass reduction and is associated with surgical morbidity and poor prognosis after pancreatoduodenectomy (PD). Sarcopenia diagnosis requires a combination of motor functional tests and skeletal muscle mass measurements. Conversely, intramuscular adipose tissue content (IMAC), an indicator of skeletal muscle quality, requires only computed tomography, providing convenient diagnostic information regarding the patient's body composition. This study aimed to clarify the impact of IMAC on surgical morbidity and prognosis in patients undergoing PD.

Methods: This study included 277 patients who underwent PD between January 2013 and December 2022. The relationship between surgical morbidity (Clavien-Dindo grade ≥ 3) and clinicopathological factors, including IMAC, was examined in all patients. Predictive factors associated with overall survival (OS) and recurrence-free survival (RFS) were evaluated in 122 pancreatic cancer patients.

Results: A high IMAC independently predicted major complications (odds ratio 1.776, P=0.046) and was independently associated with poor OS (hazard ratio [HR], 1.694; P=0.038) and RFS (HR, 1.582; P=0.038). Patients with both high IMAC and CAR ≥ 0.015 had a significantly poorer OS than those with only one of the factors (5-year survival rate, 12.3% vs. 45.8%; P<0.001).

Conclusion: IMAC, an indicator of skeletal muscle quality, provides convenient and highly valuable diagnostic information on body composition and predicts postoperative complications and prognosis in patients with malignant tumors undergoing PD.

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.