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.