Gastric mucosal abnormality and risk of pancreatic cancer: a population-based gastric biopsy cohort study in Sweden
Menée en Suède à partir de données de registres portant sur 318 653 participants ayant réalisé des biopsies gastriques entre 1979 et 2011, cette étude analyse l'association entre l'état de la muqueuse gastrique et le risque de cancer du pancréas (3 540 cas)
Background: It remains open whether gastric precancerous lesions are associated with an elevated risk of pancreatic cancer. Our aim was to investigate the association between gastric mucosal status and pancreatic cancer risk. Methods: Patients with gastric biopsies (normal, minor changes, superficial gastritis, and atrophic gastritis/intestinal metaplasia/dysplasia [AG/IM/Dys]) from the Swedish histopathology registers during 1979-2011 were included. Cross linkages with several nationwide registries allowed complete follow-up and identification of pancreatic cancer cases until 2014. Standardized incidence ratios (SIRs) and hazard ratios were estimated. Results: During 3,438,248 person-years of follow-up with 318,653 participants, 3,540 cases of pancreatic cancer were identified. The same pattern of excess risk of pancreatic cancer compared to the general population was observed across all groups: a peak of 12- to 21-fold excess risk in the first year after biopsy (e.g., normal: SIR=17.4, 95% CI 15.7-19.3; AG/IM/Dys: SIR=11.5, 95% CI 9.9-13.4) which dropped dramatically during the second and third year, followed by 20%-30% increased risk after the third year (e.g., normal: SIR=1.2, 95% CI 1.1-1.4; AG/IM/Dys: SIR=1.3, 95% CI 1.1-1.5). However, no significant excess risk was observed with the normal gastric mucosa as reference. Conclusions: This unique large pathological cohort study did not find evidence that abnormal gastric mucosal status is causally associated with a long-term pancreatic cancer risk. However, a highly increased short-term risk was observed for people undergoing gastroscopy with biopsy sampling compared with the general population. Impact: Further studies for a long-term risk of pancreatic cancer in patients with gastric biopsies are needed, with further adjustments.