Abstract
In a Swedish population, 361 patients with pernicious anemia were followed closely during a 7-year period with regard to the occurrence of all forms of malignant neoplasia. In addition to an increased incidence of gastric neoplasia (0.6%/year), there seemed to be an increased incidence of pancreatic neoplasia (0.3%/year) in the series. With reference to age- and sex-specific incidence rates in the general population, the number of malignant pancreatic tumors observed was significantly higher than expected (p<0.02, Poisson analysis). Pancreatic malignancy was the primary cause of death in 5 (4%) of 134 patients who died during follow-up. Among 127 unselected patients with malignant pancreatic neoplasia, the prevalence of pernicious anemia was 3%. These findings indicate that there is a linkage between the two diseases which has not been previously recognized. Atrophic gastritis with hypergastrinemia may be the key to this linkage.
Résumé
Trois cent soixante et un patients Suédois présentant une anémie pernicieuse ont été suivis de près pendant une période de 7 ans pour déceler l'apparition de cancer, quelque soit son type. Dans cette série, en plus d'une incidence augmentée de néoplasmes gastriques (0.6% par an), il semble que l'incidence des néoplasmes pancréatiques soit élevé aussi (0.3% par an). Le nombre de tumeurs pancréatiques malignes était supérieur à celui qu'on attendait (p<0.02 par l'analyse de Poisson) compte tenu de l'áge et du sexe des contrôles de la population générale. Une tumeur maligne était la cause de mort de 5 (4%) des 134 patients décédés par la suite. Parmi 127 patients non sélectionnés ayant une tumeur pancréatique maligne, la prévalence d'anémie pernicieuse était de 3%. Ces données suggèrent qu'il existe un rapport entre des deux maladies non reconnues auparavant. La gastrite atrophique avec hypergastrinémie pourrait être le chaînon manquant.
Resumen
Ninguno de diversos estudios comprensivos, la mayoría de los cuales no son de reciente publicación, ha indicado una aumentada incidencia de cáncer de los órganos del tracto digestivo, diferente de la reconocida mayor frecuencia del cáncer gástrico, en la anemia perniciosa. Trescientos sesenta y un pacientes con anemia perniciosa, diagnosticados en dos vecinos distritos de salud suecos, fueron investigados durante un período de seguimiento de 7 años en relación a la presencia de toda forma de neoplasia maligna. Se encontró que además de una aumentada incidencia de neoplasia gástrica (0.6% por año), hay una aparente mayor incidencia de neoplasia pancreática (0.3% por año) en esta série. En comparación con las tasas específicas de incidencia por edad y sexo en la población general, se encontró un mayor número de tumores malignos del páncreas (p<0.02 en el análisis de Poisson). La neoplasia maligna del páncreas constituyó la primera causa de muerte en 5 (4%) de 134 pacientes fallecidos en el transcurso del seguimiento. En 127 pacientes no seleccionados con neoplasia pancreática, la incidencia de anemia perniciosa fue de 3%. Estos hallazgos indican que existe una relación no previamente reconocida entre las dos enfermedades. La gastritis atrófica con hipergastrinemia bien puede ser la clave de tal relación.
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Borch, K., Kullman, E., Hallhagen, S. et al. Increased incidence of pancreatic neoplasia in pernicious anemia. World J. Surg. 12, 866–870 (1988). https://doi.org/10.1007/BF01655502
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DOI: https://doi.org/10.1007/BF01655502