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DOI: 10.1055/s-0040-1704052
THE ASSOCIATION OF ANTI-TUMOR NECROSIS FACTOR THERAPY AND COLECTOMY WITH PANCREATIC ADENOCARCINOMA IN ULCERATIVE COLITIS: FINDINGS OF A NATIONWIDE EPIDEMIOLOGICAL STUDY
Publication History
Publication Date:
23 April 2020 (online)
Aims Previous studies have reported an increased rate of pancreatic adenocarcinoma (PAC) in ulcerative colitis (UC). The pathophysiology remains unclear. We sought to evaluate the epidemiology of PAC in UC in a large database.
Methods A database (Explorys), consisting of electronic records from 26 US healthcare systems, was surveyed. Patients with new Systematized Nomenclature of Medicine-Clinical Terms diagnosis of PAC after UC diagnosis were identified (1999-2019). Gender-, race-, age-distributions and associations were described using multivariate analysis.
Results Of the 64,151,840 in the database, 155,900 (0.24%) with UC and 52,880 (0.08%) with PAC were identified. Within the UC cohort, 270 (0.17%) developed new diagnosis of PAC. Patients with UC were more likely to develop PAC when compared to patients without IBD [OR: 2.11; 95% CI: 1.87 to 2.38; p< 0.0001]. Seventy (25.93%) patients underwent colectomy with 40 prior to PAC. Multivariate analysis is presented in table. In univariate analysis, UC patients with PAC were more likely to have a history cholangitis [OR: 6.29; 95 CI%: 4.79 to 8.27; p< 0.0001], c.difficile [OR: 2.61; 95% CI: 1.87 to 3.66; p< 0.0001], beta-lactam [OR: 5.77; 95% CI: 4.40 to 7.58; p< 0.0001], cephalosporins [OR: 3.26; 95% CI: 2.53 to 4.20; p< 0.0001] and quinolones exposure [OR: 5.14; 95% CI: 3.92 to 6.75; p< 0.0001].
Conclusions We found that patients with UC were two times more likely to develop PAC. UC patients exposed to colectomy and anti-TNF were more likely to develop PAC. The associations between PAC and UC are likely related to disease severity and microbiome changes.