The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Features of Pancreatic Cancer Associated with Chronic Pancreatitis in Korean Patients

만성 췌장염에서 발생한 췌장암의 임상양상

  • Choi, Won Jung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sung Koo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Myung-Hwan (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Dong Wan (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang Soo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Do Hyun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 최원정 (울산대학교 의과대학 서울아산병원 내과) ;
  • 이성구 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김명환 (울산대학교 의과대학 서울아산병원 내과) ;
  • 서동완 (울산대학교 의과대학 서울아산병원 내과) ;
  • 이상수 (울산대학교 의과대학 서울아산병원 내과) ;
  • 박도현 (울산대학교 의과대학 서울아산병원 내과)
  • Received : 2012.02.21
  • Accepted : 2012.12.11
  • Published : 2013.07.01
⟨ Previous Next ⟩

Abstract

Background/Aims: A positive correlation between chronic pancreatitis (CP) and pancreatic cancer (PC) has been reported. The aim of this study was to compare the clinical features of PC occurring in CP versus PC without CP with the aim of contributing to the earlier detection of PC in CP patients. Methods: The study was based on a retrospective chart review performed from 1989 to 2009, of 38 PC patients with underlying CP versus controls. Results: Compared with PC without CP, PC with CP patients were younger at the time of the diagnosis of PC (57.42 vs. 63.94 years; p = 0.01), a greater percentage were smokers (71.1% vs. 50.0%, p = 0.047), and there was pancreatic duct dilatation without a mass on CT findings (15.8% vs. 2.0%, p = 0.018). There was no difference in clinical presentation at the time of PC diagnosis and the CA 19-9 level was elevated in most patients in both groups. Additionally, there was no difference between the groups in terms of resectability (39.5% vs. 26.0%; p = 0.179) or preoperative stage; however, a greater proportion of the PC with CP group underwent surgery (34.2% vs. 16.0%; p = 0.047). Conclusions: When there is a high suspicion of PC, even if no definite mass is seen on CT in CP patents, we should endeavor to make a diagnosis of PC. Active follow-up of CP patients can allow earlier detection of pancreatic cancer.

목적: 췌장암은 예후가 매우 불량한 암으로 만성 췌장염은 췌장암의 위험인자로 알려져 있는데, 본 연구에서는 이런 환자에서 발생한 췌장암의 특징을 분석하여 조기진단 가능성을 알아보고자 하였다. 방법: 1989년 1월 1일부터 2009년 4월 30일까지 서울아산병원에 췌장암으로 입원한 환자 중 만성 췌장염의 과거력이 있는 38명과 대조군으로 만성 췌장염 없이 췌장암으로 진단된 환자 중 무작위 추출을 통해 선택된 50명을 대상으로 후향적으로 두 군 간의 특징을 비교하였다. 결과: 췌장염이 있는 군과 없는 군에서 모두 남성이 많았으며 췌장암 진단 당시 나이는 췌장염 군에서 57.42 ${\pm}$ 11.55세, 췌장염 없는 군 63.94 ${\pm}$ 11.42세 (p = 0.01)로 췌장염군이 더 어렸으며 흡연은 췌장염군(71.1% vs. 50.0%, p = 0.047)이 더 높았다. 췌장암 진단 당시의 임상 증상은 두 군 간 차이가 없었다. 두 군 모두에서 췌장 두부에서 암이 가장 호발했으며(57.9% vs. 64.0%), CA 19-9 값은 대부분 상승되어 있었고, 평균값도 유의한 차이가 없었다. 진단 당시 전산화 단층 촬영 이미지는 췌장염군에서 종괴 없이 췌관확장만 존재하는 경우(15.8% vs. 2.0%, p = 0.018)가 유의하게 많았으며 진단 및 치료법에 있어 췌장염군에서 수술을 선택하는 빈도가 높았다. 결론: 췌장염군은 영상 검사에서 비전형적으로 뚜렷한 종괴 없이 췌관확장만 있는 경우가 있으므로 임상적으로 췌장암이 의심된다면 수술이나 내시경 초음파 유도하 조직 검사 등을 통하여 적극적인 진단을 하여야 한다. 췌장염군의 췌장암 진단 당시 연령이 더 어려 좀 더 적극적으로 수술을 하는 경우가 많았으므로 만성 췌장염 환자에서 추적관찰을 적극적으로 한다면 좀 더 조기에 발견하여 치료율을 높일 수 있을 것이다.

Keywords

References

  1. Niederhuber JE, Brennan MF, Menck HR. The National Cancer Data Base report on pancreatic cancer. Cancer 1995; 76:1671-1677. https://doi.org/10.1002/1097-0142(19951101)76:9<1671::AID-CNCR2820760926>3.0.CO;2-R
  2. Korea National Statistical Office. Annual report on the cause of death statics 2009 [Internet]. Seoul (KR): Korea National Statistical Office, c2010 [cited 2010 Oct 1]. Available from: http://kosis.kr/ups/ups_01List01.jsp?grp_no=1005& pubcode=YD&type=F
  3. Lee WJ. Epidemiology and risk factors in pancreatic cancer. Korean J Hepatobiliary Pancreat Surg 2004;8:61-68.
  4. Holly EA, Chaliha I, Bracci PM, Gautam M. Signs and symptoms of pancreatic cancer: a population-based casecontrol study in the San Francisco Bay area. Clin Gastroenterol Hepatol 2004;2:510-517. https://doi.org/10.1016/S1542-3565(04)00171-5
  5. Fargnoli R, Fusi I. Computerized tomography of pancreatic tumors. Tumori 1999;85(1 Suppl 1):S3-5.
  6. Simon B, Printz H. Epidemiological trends in pancreatic neoplasias. Dig Dis 2001;19:6-14. https://doi.org/10.1159/000050648
  7. Lowenfels AB, Maisonneuve P. Epidemiology and risk factors for pancreatic cancer. Best Pract Res Clin Gastroenterol 2006;20:197-209. https://doi.org/10.1016/j.bpg.2005.10.001
  8. 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. https://doi.org/10.1056/NEJM199305203282001
  9. Niederau C, Grendell JH. Diagnosis of pancreatic carcinoma: imaging techniques and tumor markers. Pancreas 1992;7: 66-86. https://doi.org/10.1097/00006676-199201000-00011
  10. Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia: Saunders, 2006.
  11. Frederick L. Greene D, Irvin D, et al. AJCC Cancer Staging Manual. 6th ed. New york: Springer, 2002.
  12. Talamini G, Bassi C, Falconi M, et al. Early detection of pancreatic cancer following the diagnosis of chronic pancreatitis. Digestion 1999;60:554-561. https://doi.org/10.1159/000007706
  13. Malka D, Hammel P, Maire F, et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut 2002;51:849-852. https://doi.org/10.1136/gut.51.6.849
  14. Howes N, Neoptolemos JP. Risk of pancreatic ductal adenocarcinoma in chronic pancreatitis. Gut 2002;51:765-766. https://doi.org/10.1136/gut.51.6.765
  15. Iordache S, Saftoiu A, Cazacu S, et al. Endoscopic ultrasound approach of pancreatic cancer in chronic pancreatitis patients in a tertiary referral centre. J Gastrointestin Liver Dis 2008;17:279-284.
  16. Song SY. Etiology and carcinogenesis of pancreatic ductal adenocarcinoma. Korean J Gastroenterol 2008;51:71-83.
  17. Gemmel C, Eickhoff A, Helmstädter L, Riemann JF. Pancreatic cancer screening: state of the art. Expert Rev Gastroenterol Hepatol 2009;3:89-96. https://doi.org/10.1586/17474124.3.1.89
  18. De Icaza E, Lopez-Cervantes M, Arredondo A, Robles-Díaz G. Likelihood ratios of clinical, laboratory and image data of pancreatic cancer: Bayesian approach. J Eval Clin Pract 2009;15:62-68. https://doi.org/10.1111/j.1365-2753.2008.00955.x
  19. Wang F, Gupta S, Holly EA. Diabetes mellitus and pancreatic cancer in a population-based case-control study in the San Francisco Bay Area, California. Cancer Epidemiol Biomarkers Prev 2006;15:1458-1463. https://doi.org/10.1158/1055-9965.EPI-06-0188
  20. Gullo L, Tomassetti P, Migliori M, Casadei R, Marrano D. Do early symptoms of pancreatic cancer exist that can allow an earlier diagnosis? Pancreas 2001;22:210-213. https://doi.org/10.1097/00006676-200103000-00017
  21. Klapman J, Malafa MP. Early detection of pancreatic cancer: why, who, and how to screen. Cancer Control 2008; 15:280-287. https://doi.org/10.1177/107327480801500402
  22. Bedi MM, Gandhi MD, Jacob G, Lekha V, Venugopal A, Ramesh H. CA 19-9 to differentiate benign and malignant masses in chronic pancreatitis: is there any benefit? Indian J Gastroenterol 2009;28:24-27. https://doi.org/10.1007/s12664-009-0005-4
  23. Peterli R, Meyer-Wyss B, Herzog U, Tondelli P. CA19-9 has no value as a tumor marker in obstructive jaundice. Schweiz Med Wochenschr 1999;129:77-79.
  24. Korean Society of Abdominal Radiology. Abdominal Radiology. 2nd ed. Seoul: Ilchokak, 2006.
  25. Dianxu F, Shengdao Z, Tianquan H, et al. A prospective study of detection of pancreatic carcinoma by combined plasma K-ras mutations and serum CA19-9 analysis. Pancreas 2002;25:336-341. https://doi.org/10.1097/00006676-200211000-00003
  26. Salek C, Benesova L, Zavoral M, et al. Evaluation of clinical relevance of examining K-ras, p16 and p53 mutations along with allelic losses at 9p and 18q in EUS-guided fine needle aspiration samples of patients with chronic pancreatitis and pancreatic cancer. World J Gastroenterol 2007;13:3714-3720. https://doi.org/10.3748/wjg.v13.i27.3714

Cited by

  1. Clinical Features of Pancreatic Cancer Associated with Chronic Pancreatitis vol.85, pp.1, 2013, https://doi.org/10.3904/kjm.2013.85.1.38