P0016 - Risk of Pancreatic Cancer After a Diagnosis of Gallbladder Disease: A Propensity Score Matched Study From a Large Multi-institutional National Database

Ghada Mohamed, MD¹, Yee Hui Yeo, MD², Gerardo Perrotta, MD², Malak Munir, MD², Amar K. Rai, MBBS³, Kenneth Park, MD², Quin Liu, MD², Rabindra Watson, MD², Stephen Pandol, MD², Ju Dong Yang, MD², Brent Larson, DO², Nicholas Nissen, MD², Kambiz Kosari, MD², Cristina Ferrone, MD², Mohammad Karim, PhD, PharmD⁴, Hye Chung Kum, PhD⁵, Kevin Ma, ⁶, Todd Baron, MD⁷, Simon Lo, MD², Srinivas Gaddam, MD, MPH^2
1Cedars-Sinai Medical Center, Burlinton, MA; ²Cedars-Sinai Medical Center, Los Angeles, CA; ³Imperial College London, Slough, England, United Kingdom; ⁴University of Nevada, Las Vegas, NV; ⁵Texas A&M, College Station, TX; ⁶Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ⁷University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC

Introduction: Identifying early clinical predictors of PC is crucial for early detection. We aimed to evaluate the association between gallbladder (GB) disease and subsequent 5-year risk of PC using a large national multi-institutional data.

Methods: Patients aged 40+ diagnosed with GB disease between January 2017 and December 2018 in the TriNetX cohort were compared with propensity score matched controls without GB disease. Demographic and clinical variables (age, sex, race, smoking, diabetes, cholelithiasis, pancreatitis, BMI, HbA1C) were matched 1:1 using propensity scores. Exclusions included pregnancy, hemolytic anemia, weight loss surgery, or history of PC/pancreatectomy. The primary outcome was annual and cumulative incidence of PC over 2 and 5 years. Multiple sensitivity analyses were performed. Joinpoint regression analysis was used to evaluate time trends.

Results: 45,388 cases and 6,182,536 controls met the inclusion criteria. Propensity score matching resulted in two cohorts of 45,388 patients each, with a standardized mean difference (SMD) of < 0.1 for each covariate. PC incidence per 100,000 was higher in GB cohort vs. controls after 2 years of follow up (228 vs. 60, RR 3.80 (95% CI: 2.8, 5.1, p< 0.01) and 5 years of follow up (RR = 2.46 (95% CI: 2.0, 3.0, p< 0.01). However, annual RR was significantly elevated only in the first 2 years suggesting that the 5-year risk of PC is explained by elevated risk in the first two years post-diagnosis of GB disease (Table 1). Joinpoint regression analysis confirmed a statistically significant trend with joinpoint at 2 years (APC=-68.7% vs 2.9%, p< 0.01) and after 2 years there was no statistical difference (APC=-12% vs. 2.9%, p=0.07) in risk of PC between GB disease and controls (Figure 1). Multiple sensitivity analyses, performed by altering the subgroups and varying the definitions of GB disease, confirmed the robustness of our results.

Discussion: Our robust analysis of population-based data demonstrates that a diagnosis of GB disease is significantly correlated with an elevated risk of developing PC. Current cross-sectional imaging can miss small pancreatic head tumors, which may cause bile duct effects that present as a dilated GB. This can lead to a misdiagnosis of GB disease or an accurate diagnosis of co-presentation of GB disease, while the diagnosis of PC may be missed. This explains the elevated risk of PC for 2 years, necessitating a careful inspection of the pancreas to enable early diagnosis.



Disclosures:


Ghada Mohamed, MD¹, Yee Hui Yeo, MD², Gerardo Perrotta, MD², Malak Munir, MD², Amar K. Rai, MBBS³, Kenneth Park, MD², Quin Liu, MD², Rabindra Watson, MD², Stephen Pandol, MD², Ju Dong Yang, MD², Brent Larson, DO², Nicholas Nissen, MD², Kambiz Kosari, MD², Cristina Ferrone, MD², Mohammad Karim, PhD, PharmD⁴, Hye Chung Kum, PhD⁵, Kevin Ma, ⁶, Todd Baron, MD⁷, Simon Lo, MD², Srinivas Gaddam, MD, MPH². P0016 - Risk of Pancreatic Cancer After a Diagnosis of Gallbladder Disease: A Propensity Score Matched Study From a Large Multi-institutional National Database, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.