Chronische Pankreatitis und Pankreaskarzinom – Tumorrisiko und Screening

Georg Beyer; Jan G. D’Haese; Steffen Ormanns; Julia Mayerle

doi:10.1055/s-0043-125407

DMW - Deutsche Medizinische Wochenschrift, Inhaltsverzeichnis

Dtsch Med Wochenschr 2018; 143(12): 895-906
DOI: 10.1055/s-0043-125407

CME-Fortbildung

Chronische Pankreatitis und Pankreaskarzinom – Tumorrisiko und Screening

Chronic Pancreatitis and Pancreatic Cancer – Tumor Risk and Screening

Autor*innen

Georg Beyer
Jan G. D’Haese
Steffen Ormanns
Julia Mayerle

Abstract

Chronic pancreatitis is a fibroinflammatory syndrome of the exocrine pancreas, which is characterized by an increasing incidence, high morbidity and lethality. Common etiologies besides alcohol and nicotine consumption include genetic causes and risk factors. The life time risk for the development of pancreatic cancer is elevated 13- to 45-fold depending on the underlying etiology. In patients with chronic pancreatitis clinical, laboratory and imaging surveillance for early detection of complications, including pancreatic cancer, is recommended, although the available methods lack the desired sensitivity and specificity. In this article we review the epidemiology, etiologies and risk factors for chronic pancreatitis and pancreatic cancer and discuss current recommendations for screening and management of patients at risk for tumor development.

Die chronische Pankreatitis ist durch steigende Inzidenz sowie erhöhte Morbidität und Letalität gekennzeichnet: Das Lebenszeitrisiko für ein Pankreaskarzinom ist je nach Ätiologie 13- bis 45-fach erhöht. Dieser Beitrag fasst Epidemiologie, Ursachen und Risikofaktoren für chronische Pankreatitis und Pankreaskarzinom zusammen. Die aktuellen Empfehlungen zu Überwachung und Management von Patienten mit erhöhtem Tumorrisiko werden diskutiert.

Schlüsselwörter

chronische Pankreatitis - Pankreaskarzinom - Tumorscreening - Diabetes mellitus Typ 3c

Key words

chronic pancreatitis - pancreatic cancer - tumor screening - type 3c diabetes

Volltext

Referenzen

Literatur
1 Hoffmeister A, Mayerle J, Beglinger C. et al. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol 2015; 53: 1447-1495
2 Machicado JD, Amann ST, Anderson MA. et al. Quality of life in chronic pancreatitis is determined by constant pain, disability/unemployment, current smoking, and associated co-morbidities. Am J Gastroenterol 2017; 112: 633-642
3 Gastard J, Joubaud F, Farbos T. et al. Etiology and course of primary chronic pancreatitis in Western France. Digestion 1973; 9: 416-428
4 Löhr JM, Dominguez-Munoz E, Rosendahl J. et al. HaPanEU/UEG Working Group. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J 2017; 5: 153-199
5 Whitcomb DC, Frulloni L, Garg P. et al. Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. Pancreatology 2016; 16: 218-224
6 Kleeff J, Whitcomb DC, Shimosegawa T. et al. Chronic pancreatitis. Nat Rev Dis Primers 2017; 3: 17060
7 Sankaran SJ, Xiao AY, Wu LM. et al. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology 2015; 149: 1490-1500.e1
8 Spanier BWM, Dijkgraaf MGW, Bruno MJ. Trends and forecasts of hospital admissions for acute and chronic pancreatitis in the Netherlands. Eur J Gastroenterol Hepatol 2008; 20: 653-658
9 Machicado JD, Yadav D. Epidemiology of recurrent acute and chronic pancreatitis: similarities and differences. Dig Dis Sci 2017; 62: 1683-1691
10 Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013; 144: 1252-1261
11 Conwell DL, Banks PA, Sandhu BS. et al. Validation of demographics, etiology, and risk factors for chronic pancreatitis in the usa: a report of the North American Pancreas Study (NAPS) Group. Dig Dis Sci 2017; 62: 2133-2140
12 Lin Y, Tamakoshi A, Hayakawa T. et al. Research Committee on Intractable Pancreatic Diseases. Associations of alcohol drinking and nutrient intake with chronic pancreatitis: findings from a case-control study in Japan. Am J Gastroenterol 2001; 96: 2622-2627
13 Lévy P, Mathurin P, Roqueplo A. et al. A multidimensional case-control study of dietary, alcohol, and tobacco habits in alcoholic men with chronic pancreatitis. Pancreas 1995; 10: 231-238
14 Zator Z, Whitcomb DC. Insights into the genetic risk factors for the development of pancreatic disease. Ther Adv Gastroenterol 2017; 10: 323-336
15 Andriulli A, Botteri E, Almasio PL. et al. ad hoc Committee of the Italian Association for the Study of the Pancreas. Smoking as a cofactor for causation of chronic pancreatitis: a meta-analysis. Pancreas 2010; 39: 1205-1210
16 Ahmed AliU, Issa Y, Hagenaars JC. et al. Dutch Pancreatitis Study Group. Risk of recurrent pancreatitis and progression to chronic pancreatitis after a first episode of acute pancreatitis. Clin Gastroenterol Hepatol 2016; 14: 738-746
17 Bang UC, Benfield T, Hyldstrup L. et al. Mortality, cancer, and comorbidities associated with chronic pancreatitis: a Danish nationwide matched-cohort study. Gastroenterology 2014; 146: 989-994
18 Nøjgaard C, Bendtsen F, Becker U. et al. Danish patients with chronic pancreatitis have a four-fold higher mortality rate than the Danish population. Clin Gastroenterol Hepatol 2010; 8: 384-390
19 Yadav D, Timmons L, Benson JT. et al. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol 2011; 106: 2192-2199
20 Lankisch PG, Breuer N, Bruns A. et al. Natural history of acute pancreatitis: a long-term population-based study. Am J Gastroenterol 2009; 104: 2797-2805 quiz 2806
21 Rahib L, Smith BD, Aizenberg R. et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 2014; 74: 2913-2921
22 Quante AS, Ming C, Rottmann M. et al. Projections of cancer incidence and cancer-related deaths in Germany by 2020 and 2030. Cancer Med 2016; 5: 2649-2656
23 Lowenfels AB, Maisonneuve P, Cavallini G. et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993; 328: 1433-1437
24 Kirkegård J, Mortensen FV, Cronin-Fenton D. Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol 2017; 112: 1366-1372
25 Golan T, Sella T, Margalit O. et al. Short- and long-term survival in metastatic pancreatic adenocarcinoma, 1993–2013. J Natl Compr Cancer Netw 2017; 15: 1022-1027
26 Mayerle J, Kalthoff H, Reszka R. et al. Metabolic biomarker signature to differentiate pancreatic ductal adenocarcinoma from chronic pancreatitis. Gut 2018; 67: 128-137
27 Hao L, Zeng XP, Xin L. et al. Incidence of and risk factors for pancreatic cancer in chronic pancreatitis: A cohort of 1656 patients. Dig Liver Dis 2017; 49: 1249-1256
28 Han S, Kheder J, Bocelli L. et al. Smoking cessation in a chronic pancreatitis population. Pancreas 2016; 45: 1303-1308
29 Whitcomb DC, Shelton CA, Brand RE. Genetics and genetic testing in pancreatic cancer. Gastroenterology 2015; 149: 1252-1264.e4
30 Syngal S, Brand RE, Church JM. et al. ACG Clinical Guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol 2015; 110: 223-262
31 Harinck F, Konings IC, Kluijt I. et al. Dutch research group on pancreatic cancer surveillance in high-risk individuals. A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals. Gut 2016; 65: 1505-1513
32 Hart PA, Bellin MD, Andersen DK. et al. Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer(CPDPC). Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol 2016; 1: 226-237
33 Ewald N, Kaufmann C, Raspe A. et al. Prevalence of diabetes mellitus secondary to pancreatic diseases (type 3c). Diabetes Metab Res Rev 2012; 28: 338-342
34 Das SL, Kennedy JI, Murphy R. et al. Relationship between the exocrine and endocrine pancreas after acute pancreatitis. World J Gastroenterol 2014; 20: 17196-17205
35 Das SL, Singh PP, Phillips AR. et al. Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis. Gut 2014; 63: 818-831
36 Ewald N, Bretzel RG. Diabetes mellitus secondary to pancreatic diseases (Type 3c) – are we neglecting an important disease?. Eur J Intern Med 2013; 24: 203-206
37 Pan J, Xin L, Wang D. et al. Risk factors for diabetes mellitus in chronic pancreatitis: a cohort of 2,011 patients. Medicine (Baltimore) 2016; 95: e3251
38 Pannala R, Leirness JB, Bamlet WR. et al. Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus. Gastroenterology 2008; 134: 981-987
39 Andersen DK, Korc M, Petersen GM. et al. Diabetes, pancreatogenic diabetes, and pancreatic cancer. Diabetes 2017; 66: 1103-1110
40 Colmers IN, Bowker SL, Tjosvold LA. et al. Insulin use and cancer risk in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies. Diabetes Metab 2012; 38: 485-506
41 Madiraju AK, Erion DM, Rahimi Y. et al. Metformin suppresses gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase. Nature 2014; 510: 542-546
42 Rickels MR, Bellin M, Toledo FG. et al. PancreasFest Recommendation Conference Participants. Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: recommendations from PancreasFest 2012. Pancreatology 2013; 13: 336-342