Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2025; 17(8): 109743
Published online Aug 15, 2025. doi: 10.4251/wjgo.v17.i8.109743
Clinical characteristics and diagnostic factors of tumor-associated acute pancreatitis: A comparative analysis of early vs delayed diagnosis
Chuan-Chao Xia, Long-Gui Ning, Yue Xu, Guo-Qiang Xu
Chuan-Chao Xia, Long-Gui Ning, Yue Xu, Guo-Qiang Xu, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Co-first authors: Chuan-Chao Xia and Long-Gui Ning.
Author contributions: Xia CC wrote the manuscript; Xia CC, Ning LG and Xu Y contributed to the data collection and analysis; Xu GQ contributed to the methodology and revising the manuscript; All authors have read and approve the final manuscript.
Supported by the National Natural Science Foundation of China, No. 8217030254.
Institutional review board statement: The study was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No. IIT2025016B).
Informed consent statement: Written informed consent was applied for exemption considering the retrospective study design.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets analyzed in this study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Qiang Xu, Professor, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. 1193065@zju.edu.cn
Received: May 21, 2025
Revised: May 28, 2025
Accepted: June 23, 2025
Published online: August 15, 2025
Processing time: 85 Days and 22.3 Hours
Abstract
BACKGROUND

Acute pancreatitis (AP) is a leading gastrointestinal cause of hospitalization worldwide. While gallstones, alcohol use, and hypertriglyceridemia account for most cases, pancreatic malignancy remains an underdiagnosed but critical etiology requiring prompt identification due to its significant prognostic implications.

AIM

To systematically evaluate the clinical characteristics of tumor-associated AP and identify risk factors influencing early diagnosis.

METHODS

This retrospective cohort study analyzed 167 patients with pancreatic cancer-associated AP (2014-2023), stratified by diagnostic timing: Early-diagnosis (n = 75, identified during initial AP admission) vs delayed-diagnosis (n = 92, requiring ≥ 2 admissions). Multivariable logistic regression was performed to determine independent predictors of early cancer detection.

RESULTS

The early-diagnosis group demonstrated distinct clinical and biochemical signatures, with independent predictors including: Diabetes history [odds ratio (OR) = 2.69, 95% confidence interval (CI): 1.08-3.34], concurrent AP etiologies (OR = 4.77, 95%CI: 1.84-7.81), elevated carbohydrate antigen 19-9 (OR = 1.38, 95%CI: 1.03-1.84), hyperbilirubinemia (direct: OR = 2.36, 95%CI: 1.35-3.48; indirect: OR = 2.67, 95%CI: 1.38-4.62), and serum glucose (OR = 1.42, 95%CI: 1.08-2.55).

CONCLUSION

Key high-risk indicators for occult pancreatic malignancy in tumor- associated AP patients include: Advanced age, pre-existing diabetes mellitus, hyperbilirubinemia, and concurrent with conventional AP etiologies. These findings advocate for enhanced surveillance protocols incorporating serial tumor markers and multimodal imaging to earlier cancer detection.

Keywords: Acute pancreatitis; Pancreatic cancer; Pancreatic ductal adenocarcinoma; Early diagnosis; Clinical characteristics

Core Tip: Although pancreatic malignancies represent a relatively infrequent etiology of acute pancreatitis (AP), their association with adverse clinical outcomes necessitates prompt diagnostic evaluation. In this retrospective cohort study, significant differences in clinical characteristics, disease progression, and healthcare utilization were observed between the early and delayed diagnosis patients. Multivariable logistic analysis indicated that advanced age, pre-existing diabetes mellitus, hyperbilirubinemia, and concurrent with conventional AP etiologies are key high-risk indicators for occult pancreatic malignancy in tumor-associated AP patients.