RISK OF PANCREATIC-CARCINOMA IN TROPICAL CALCIFYING PANCREATITIS - ANEPIDEMIOLOGIC-STUDY

To assess the risk of pancreatic cancer in subjects with tropical calc ifying pancreatitis (TCP), we have followed 185 patients with TCP from the Diabetes Research Center in Madras, India for an average of 4.5 y ears. The diagnosis of TCP was based upon long-standing epigastric pai n, laboratory tests, presence of pancreatic calculi, endoscopic retrog rade cholangiopan-creatography (ERCP) findings, and ultrasonography. D uring the follow-up period, 24 patients died from all causes, with 6 d eaths (25%) from cancer of the pancreas. Three pancreatic cancers were biopsy positive. Average age at onset of pancreatic cancer was 45.6 /- 7.3 years-considerably younger than for Western populations. When c ompared with the background pancreatic cancer rate, subjects with TCP appear to have a significantly increased risk of pancreatic cancer: re lative risk = 100, 95% Cl = 37-218. Even under the most stringent assu mptions (restricting the analysis to biopsy-proven cases, assuming tha t the true background rate of pancreatic cancer in Madras resembles hi gh-risk Western populations, assuming that tropical pancreatitis begin s at birth) the risk is still elevated: relative fisk = 5, 95% Cl = 1. 03-3-14.6. The exact mechanism linking various forms of pancreatitis t o pancreatic cancer remains to be elucidated.