Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, EC1M 6BQ, UK.
Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
BMC Cancer. 2021 Nov 27;21(1):1279. doi: 10.1186/s12885-021-09014-w.
Pancreatic cancer risk is poorly quantified in relation to the temporal presentation of medical comorbidities and lifestyle. This study aimed to examine this aspect, with possible influence of demographics.
We conducted a retrospective case-control study on the ethnically-diverse population of East London, UK, using linked electronic health records. We evaluated the independent and two-way interaction effects of 19 clinico-demographic factors in patients with pancreatic cancer (N = 965), compared with non-malignant pancreatic conditions (N = 3963) or hernia (control; N = 4355), reported between April 1, 2008 and March 6, 2020. Risks were quantified by odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression models.
We observed increased odds of pancreatic cancer incidence associated with recent-onset diabetes occurring within 6 months to 3 years before cancer diagnosis (OR 1.95, 95% CI 1.25-3.03), long-standing diabetes for over 3 years (OR 1.74, 95% CI 1.32-2.29), recent smoking (OR 1.81, 95% CI 1.36-2.4) and drinking (OR 1.76, 95% CI 1.31-2.35), as compared to controls but not non-malignant pancreatic conditions. Pancreatic cancer odds was highest for chronic pancreatic disease patients (recent-onset: OR 4.76, 95% CI 2.19-10.3, long-standing: OR 5.1, 95% CI 2.18-11.9), amplified by comorbidities or harmful lifestyle. Concomitant diagnosis of diabetes, upper gastrointestinal or chronic pancreatic conditions followed by a pancreatic cancer diagnosis within 6 months were common, particularly in South Asians. Long-standing cardiovascular, respiratory and hepatobiliary conditions were associated with lower odds of pancreatic cancer.
Several factors are, independently or via effect modifications, associated with higher incidence of pancreatic cancer, but some established risk factors demonstrate similar magnitude of risk measures of developing non-malignant pancreatic conditions. The findings may inform refined risk-stratification strategies and better surveillance for high-risk individuals, and also provide a means for systematic identification of target population for prospective cohort-based early detection research initiatives.
与医疗合并症和生活方式的时间表现相关的胰腺癌风险量化程度较差。本研究旨在研究这一方面，可能会受到人口统计学的影响。
我们在英国伦敦东部的种族多样化人群中进行了一项回顾性病例对照研究，使用了电子健康记录。我们评估了 19 种临床人口统计学因素在胰腺癌患者（n=965）中的独立和双向交互作用，与非恶性胰腺疾病（n=3963）或疝（对照组；n=4355）相比，报告时间为 2008 年 4 月 1 日至 2020 年 3 月 6 日。使用多变量逻辑回归模型计算风险比（OR）和 95%置信区间（CI）。
我们观察到，与对照组相比，在癌症诊断前 6 个月至 3 年内新发糖尿病（OR 1.95，95%CI 1.25-3.03）、长期糖尿病（OR 1.74，95%CI 1.32-2.29）、近期吸烟（OR 1.81，95%CI 1.36-2.4）和饮酒（OR 1.76，95%CI 1.31-2.35）的患者胰腺癌发病风险增加，但与非恶性胰腺疾病患者相比，这种风险增加并不明显。与对照组相比，慢性胰腺疾病患者的胰腺癌发病风险最高（新发：OR 4.76，95%CI 2.19-10.3，长期：OR 5.1，95%CI 2.18-11.9），并且与合并症或有害生活方式呈放大关系。在 6 个月内同时诊断出糖尿病、上消化道或慢性胰腺疾病并随后诊断出胰腺癌的情况很常见，特别是在南亚人群中。长期心血管、呼吸和肝胆疾病与较低的胰腺癌发病风险相关。
一些因素独立或通过相互作用与胰腺癌发病率的增加相关，但一些已确定的危险因素与非恶性胰腺疾病的风险度量具有相似的风险。这些发现可以为风险分层策略的制定提供信息，并为高危人群提供更好的监测，还为系统确定前瞻性队列研究早期检测目标人群提供了一种手段。
