GALLSTONE DISEASE IN THE YEAR PRIOR TO PANCREATIC CANCER DIAGNOSIS: AN OPPORTUNITY FOR ACTION
Marianna V. Papageorge*1, Susanna W. de Geus1, Alison P. Woods1,2, Sing Chau Ng1, David Mcaneny1, Jennifer F. Tseng1, Kelly Kenzik3,1, Teviah Sachs1
1Department of Surgery, Boston Medical Center, Boston, MA; 2Johns Hopkins University School of Medicine, Baltimore, MD; 3The University of Alabama at Birmingham School of Medicine, Birmingham, AL
Introduction: Patients with pancreatic cancer can present with a variety of insidious abdominal symptoms, complicating initial diagnosis. Early symptoms often mirror those associated with cholelithiasis or cholecystitis, both of which have been demonstrated to be risk factors for pancreatic cancer. Despite this association, little is known about the true incidence of these pathologies antecedent to the diagnosis of pancreatic cancer. The purpose of the present study was to compare the incidence of cholelithiasis or cholecystitis in the year prior to a diagnosis of pancreatic ductal adenocarcinoma (PDAC) and the annual incidence in the general population.
Methods: Patients with PDAC were identified from SEER-Medicare (2008-2015). The incidence of hospital visits for gallstone disease (defined as cholelithiasis or cholecystitis) and cholecystectomy in the 1 year prior to cancer diagnosis, as well as the annual incidence in the SEER-Medicare non-cancer cohort, was assessed. A one-month washout period prior to diagnosis was employed for the cancer cohort.
Results: A total of 18,700 patients with PDAC were identified, of whom 4.7% had gallstone disease diagnosed and 1.6% underwent cholecystectomy in the year prior to diagnosis. An average of 99,287 patients per year were available from the non-cancer cohort, 0.8% of whom had gallstone disease per year and 0.3% underwent cholecystectomy per year. Among patients with PDAC, the median age was 76 (IQR 71, 82) and the majority of patients were female (52.8%) and white (85.4%) with stage IV disease (49.0%). Patients with gallstone disease were diagnosed at an earlier disease stage (stage I-II) (47.9% versus 40.5%, p<0.0001) and a higher proportion underwent pancreaticoduodenectomy (17.6% versus 12.9%, p<0.0001), as compared to patients without gallstone disease.
Conclusion: Patients in the year prior to PDAC diagnosis present with gallstone disease almost 6 times more often than the general population. Improving differential diagnosis strategies may help combat the high mortality rate in PDAC by providing an opportunity for earlier stage of diagnosis and earlier intervention and treatment in these patients.
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