Aslam Syed, MD, Talal Seoud, MD, Shyam Thakkar, MD; Allegheny Health Network, Pittsburgh, PA
Introduction: Pancreatic cancer (PaC) remains the fourth leading cause of all cancer related deaths in the USA. Continuous efforts are being established to identify patients with predisposing risk factors for PaC. We aim to establish the incidence and risk factors for PaC after detection of H pylori using a large cohort of patients in the USA and identify how treatment affects cancer risk. Methods: A population-based study was conducted using a cloud-based, HIPAA-enabled web platform called Explorys to collect aggregated de-identified electronic health records from 1999-2019. SNOMED criteria was utilized to identify patients with “malignant tumor of pancreas” and “Helicobacter pylori” infection including 1) positive stool antigen test, 2) positive serum antibody (first time occurrence) and 3) presence of H pylori infection (first time occurrence). A temporal relationship was established to evaluate the incidence of PaC after positive H pylori detection. The role of treatment was also established by searching for drug ingredients amoxicillin, clarithromycin, tetracycline, metronidazole (in combination therapy) and pharmacology class of proton-pump inhibitors. The primary outcome was a diagnosis of pancreatic cancer 30 days or more after detection of H pylori infection. Secondary outcomes evaluated all-cause mortality, and the role of PaC incidence after H pylori treatment. Standardized incidence ratios (SIR) and odds ratios (OR) were calculated and analyzed. Results: Explorys identified 205,120 patients with H pylori infection, of which 850 developed PaC. In comparison, 470 patients were identified with PaC after H pylori infection with an established treatment regime. Patients who received treatment for their H pylori infection had a decreased risk of PaC vs. those without treatment (SIR 0.4% vs. 0.2%, P< 0.0001). Males, elderly patients ( >65) and African-Americans were more prone to develop PaC after H pylori infection, regardless of treatment. Tobacco use increased risk of PaC regardless of H pylori infection. All-cause mortality significantly increased with the presence of PaC, with or without treatment of H pylori infection. Discussion: In this large-population based study, diagnosis of H pylori infection was found to have a significantly higher risk of pancreatic cancer in males, African-Americans, elderly patients, and smokers. Treatment of H pylori infection decreased the risk of pancreatic cancer. Longitudinal prospective studies are necessary to further delineate this relationship.
Disclosures: Aslam Syed indicated no relevant financial relationships. Talal Seoud indicated no relevant financial relationships. Shyam Thakkar indicated no relevant financial relationships.