Background: It remains open whether gastric precancerous lesions are associated with an elevated risk of pancreatic cancer. Our aim was to investigate the association between gastric mucosal status and pancreatic cancer risk. Methods: Patients with gastric biopsies [normal, minor changes, superficial gastritis, and atrophic gastritis/intestinal metaplasia/dysplasia (AG/IM/Dys)] from the Swedish histopathology registers during 1979 to 2011 were included. Cross-linkages with several nationwide registries allowed complete follow-up and identification of pancreatic cancer cases until 2014. Standardized incidence ratios (SIR) and HRs were estimated. Results: During 3,438,248 person-years of follow-up with 318,653 participants, 3,540 cases of pancreatic cancer were identified. The same pattern of excess risk of pancreatic cancer compared with the general population was observed across all groups: a peak of 12- to 21-fold excess risk in the first year after biopsy [e.g., normal: SIR = 17.4; 95% confidence interval (CI), 15.7–19.3; AG/IM/Dys: SIR = 11.5; 95% CI, 9.9–13.4], which dropped dramatically during the second and third years, followed by 20% to 30% increased risk after the third year (e.g., normal: SIR = 1.2; 95% CI, 1.1–1.4; AG/IM/Dys: SIR = 1.3; 95% CI, 1.1–1.5). However, no significant excess risk was observed with the normal gastric mucosa as reference. Conclusions: This unique, large pathologic cohort study did not find evidence that abnormal gastric mucosal status is causally associated with a long-term pancreatic cancer risk. However, a highly increased short-term risk was observed for people undergoing gastroscopy with biopsy sampling compared with the general population. Impact: Further studies for a long-term risk of pancreatic cancer in patients with gastric biopsies are needed, with further adjustments.

中文翻译：

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胃粘膜异常和胰腺癌风险：瑞典一项基于人群的胃活检队列研究

背景：胃癌前病变是否与胰腺癌风险升高有关，目前尚无定论。我们的目的是调查胃粘膜状态与胰腺癌风险之间的关联。方法：纳入 1979 年至 2011 年间瑞典组织病理学登记处的胃活检患者[正常、微小变化、浅表性胃炎和萎缩性胃炎/肠化生/发育异常 (AG/IM/Dys)]。与几个全国性登记处的交叉联系允许在 2014 年之前对胰腺癌病例进行完整的随访和鉴定。估计了标准化发病率 (SIR) 和 HR。结果：在 3,438,248 人年的随访期间，共有 318,653 名参与者，确定了 3,540 例胰腺癌病例。与一般人群相比，在所有人群中均观察到相同的胰腺癌超额风险模式：活检后第一年的超额风险峰值为 12 至 21 倍 [例如，正常：SIR = 17.4；95% 置信区间 (CI)，15.7–19.3；AG/IM/Dys：SIR = 11.5；95% CI，9.9–13.4]，在第二年和第三年急剧下降，第三年后风险增加 20% 至 30%（例如，正常：SIR = 1.2；95% CI，1.1–1.4；AG /IM/Dys：SIR = 1.3；95% CI，1.1–1.5）。然而，以正常胃粘膜作为参考，未观察到明显的额外风险。结论：这项独特的大型病理队列研究没有发现异常胃粘膜状态与长期胰腺癌风险存在因果关系的证据。然而，与一般人群相比，接受胃镜检查和活检取样的人的短期风险大大增加。影响：需要进一步研究胃活检患者患胰腺癌的长期风险，并进行进一步调整。