Risk of pancreatic cancer in individuals with celiac disease in the United States: A population-based matched cohort study

Arunkumar Krishnan; Yousaf Bashir Hadi; Sarah Shabih; Diptasree Mukherjee; Ruhee A Patel; Rushik Patel; Shailendra Singh; Shyam Thakkar

doi:10.4251/wjgo.v15.i3.523

Risk of pancreatic cancer in individuals with celiac disease in the United States: A population-based matched cohort study

World J Gastrointest Oncol. 2023 Mar 15;15(3):523-532. doi: 10.4251/wjgo.v15.i3.523.

Authors

Arunkumar Krishnan¹, Yousaf Bashir Hadi², Sarah Shabih², Diptasree Mukherjee³, Ruhee A Patel², Rushik Patel², Shailendra Singh², Shyam Thakkar²

Affiliations

¹ Section of Gastroenterology & Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States. dr.arunkumar.krishnan@gmail.com.
² Section of Gastroenterology & Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States.
³ Department of Medicine, Apex Institute of Medical Science, Kolkata 700075, West Bengal, India.

Abstract

Background: Celiac disease (CD) has been associated with gastrointestinal malignancies. However, the magnitude of the risk of pancreatic cancer (PC) associated with CD is much less clear, and risks have not been estimated from large populations.

Aim: To assess the risk of PC in CD patients.

Methods: We conducted a population-based, multicenter, propensity score-matched cohort study with consecutive patients diagnosed with CD using the TriNeTx research network platform. We examined the incidence of PC in patients with CD compared with a matched cohort of patients without CD (non-CD, controls). Each patient in the main group (CD) was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects. The incidence of PC was estimated using a Cox proportional hazards model with a hazard ratio (HR) and 95% confidence interval (CI).

Results: A total of 389980 patients were included in this study. Among them, 155877 patients had a diagnosis of CD, and the remaining 234103 individuals without CD were considered a control cohort. The mean duration of follow-up for patients in the CD and control cohorts was 5.8 ± 1.8 and 5.9 ± 1.1 years, respectively. During the follow-up, 309 patients with CD developed PC, whereas 240 patients developed PC in the control group (HR = 1.29; 95%CI: 1.09-1.53). In the secondary analyses in the first year after diagnosis of CD, patients with CD were at a significant increase in risk for PC; 151 patients with CD had an incidence of PC compared with 96 incidences of PC among the patients in the non-CD control group (HR = 1.56; 95%CI: 1.20-2.01) and sensitivity analysis showed similar magnitude to the one generated in the primary and secondary analysis.

Conclusion: Patients with CD are at increased risk of PC. Risk elevation persists beyond the first year after diagnosis to reference individuals without CD from the general population.

Keywords: Cancer; Carcinoma; Celiac disease; Epidemiology; Malignancy; Pancreas; Pancreatic cancer.