Raimondi Sara, Maisonneuve Patrick, Löhr J-Matthias, Lowenfels Albert B
Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Cancer Epidemiol Biomarkers Prev. 2007 Sep;16(9):1894-7. doi: 10.1158/1055-9965.EPI-07-0341.
Pancreatic cancer ranks 4th as a cause of cancer mortality and in approximately 5% to 10% of patients, this lethal tumor develops before age 50. We used age-, sex-, and country-specific cancer incidence and mortality data to describe the burden of early onset pancreatic cancer (EOPC) worldwide. We also reviewed the current published evidence on smoking and genetic factors associated with EOPC. We found an excess of EOPC resulting in a substantial number of years-of-life-lost in countries from Central and Eastern Europe. Worldwide, the proportion of EOPC is strongly correlated with lung cancer mortality (R(2) = 0.53), suggesting that approximately half of the variation in the proportion of EOPC could be explained by smoking. The unusual pattern of the incidence of pancreatic cancer by gender and race supports the primary role of smoking in the etiology of EOPC: the excess male-to-female rate ratio, attributable mainly to smoking, gradually approaches unity with increasing age. Moreover, male-to-female rate ratios are greater in blacks than in whites only in younger patients. Published studies also identified genetic alterations involved either alone or in association with smoking in the development of EOPC. In conclusion, EOPC constitutes only 1% to 5% of the total deaths from pancreatic cancer worldwide, but is responsible for 20% to 30% of the total number of years-of-life-lost caused by the disease. Smoking and genetic mutations are the major identified risk factors and seem to be even more important for EOPC than for PC in older age groups.
胰腺癌是癌症死亡的第四大原因，约5%至10%的患者在50岁之前就患上了这种致命肿瘤。我们使用了按年龄、性别和国家划分的癌症发病率和死亡率数据来描述全球早发性胰腺癌（EOPC）的负担。我们还回顾了目前已发表的关于与EOPC相关的吸烟和遗传因素的证据。我们发现，在中欧和东欧国家，EOPC过多导致大量生命年损失。在全球范围内，EOPC的比例与肺癌死亡率密切相关（R² = 0.53），这表明EOPC比例约一半的变化可能由吸烟来解释。胰腺癌按性别和种族的发病率异常模式支持了吸烟在EOPC病因学中的主要作用：主要归因于吸烟的男性与女性发病率之比随着年龄增长逐渐接近1。此外，仅在年轻患者中，黑人的男性与女性发病率之比高于白人。已发表的研究还确定了在EOPC发生过程中单独或与吸烟相关的基因改变。总之，EOPC仅占全球胰腺癌总死亡人数的1%至5%，但却占该疾病导致的总生命年损失数的20%至30%。吸烟和基因突变是已确定的主要风险因素，而且对于EOPC来说，它们在老年人群中似乎比在普通胰腺癌中更为重要。
