S213 Incidence of Pancreatic Cancer in Patients With Non-Alcohol-Associated Chronic Pancreatitis: A Multi-Center Cohort Study Using Real-World Data

Introduction: Chronic pancreatitis (CP) is associated with long-term complications, including an elevated risk of pancreatic cancer (PC). While alcohol-related CP is a known risk factor for PC, the cancer risk associated with non-alcohol-associated chronic pancreatitis (NA-CP) is less well defined. This study aimed to assess the incidence of PC in patients with NA-CP using a national database. Methods: A retrospective cohort analysis was conducted using the TriNetX U.S. Collaborative Network, which includes de-identified electronic health records from 69 healthcare organizations. Adults (≥18 years) with a diagnosis of “other chronic pancreatitis” (ICD-10: K86.1) were included in the NA-CP cohort. This code encompasses non-alcoholic forms of chronic pancreatitis, including idiopathic, hereditary, obstructive, and autoimmune etiologies. Patients with a prior diagnosis of PC (ICD-10: C25.x) were excluded. A control cohort was defined by patients undergoing general adult medical examinations without abnormal findings (ICD-10: Z00.00). Propensity score matching was performed (1:1) to balance demographics and comorbidities, resulting in 189,342 patients in each cohort. Outcomes were assessed over a 10-year period starting 1 day after the index diagnosis. Results: Following exclusions, 179,042 NA-CP patients and 189,140 controls were included in the final analysis. PC was diagnosed in 7,609 NA-CP patients (4.2%) and 408 controls (0.2%). The risk ratio was 19.7 (95% CI: 17.8–21.8), and the odds ratio was 20.5 (95% CI: 18.6–22.7), both highly significant (P < 0.001). Kaplan-Meier survival analysis revealed a 10-year survival probability of 93.6% in the NA-CP cohort compared to 99.5% in controls, with a hazard ratio of 21.9 (95% CI: 19.8–24.2, P < 0.001). Median survival was not reached in either group. Median follow-up duration was 923 days for NA-CP patients and 1,335 days for controls. Conclusion: NA-CP is strongly associated with an increased risk of PC, with a nearly 20-fold elevation in risk compared to matched individuals without pancreatitis. These findings underscore the potential oncogenic impact of chronic pancreatic inflammation in non-alcoholic etiologies. Future studies incorporating clinical, serologic, and histologic data are needed to refine risk stratification and inform targeted surveillance strategies.