Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Gastroenterology. 2023 May;164(6):978-989.e6. doi: 10.1053/j.gastro.2023.01.022. Epub 2023 Feb 10.
BACKGROUND & AIMS: Previous studies have shown an increasing incidence of pancreatic cancer (PC), especially in younger women; however, this has not been externally validated. In addition, there are limited data about contributing factors to this trend. We report age and sex-specific time-trend analysis of PC age-adjusted incidence rates (aIRs) using the National Program of Cancer Registries database without Surveillance Epidemiology and End Results data.
PC aIR, mortality rates, annual percentage change, and average annual percentage change (AAPC) were calculated and assessed for parallelism and identicalness. Age-specific analyses were conducted in older (≥55 years) and younger (<55 years) adults. PC incidence based on demographics, tumor characteristics, and mortality were evaluated in younger adults.
A total of 454,611 patients were diagnosed with PC between 2001 and 2018 with significantly increasing aIR in women (AAPC = 1.27%) and men (AAPC = 1.14%) without a difference (P = .37). Similar results were seen in older adults. However, in younger adults (53,051 cases; 42.9% women), women experienced a greater increase in aIR than men (AAPCs = 2.36%, P < .001 vs 0.62%, P = 0.62) with nonparallel trends (P < .001) and AAPC difference of 1.74% (P < .001). This AAPC difference appears to be due to rising aIR in Blacks (2.23%; P < .001), adenocarcinoma histopathologic subtype (0.89%; P = .003), and location in the head-of-pancreas (1.64%; P < .001). PC mortality was found to be unchanged in women but decreasing in counterpart men (AAPC difference = 0.54%; P = .001).
Using nationwide data, covering ≈64.5% of the U.S. population, we externally validate a rapidly increasing aIR of PC in younger women. There was a big separation of the incidence trend between women and men aged 15-34 years between 2001 and 2018 (>200% difference), and it did not show slowing down.
先前的研究表明，胰腺癌（PC）的发病率呈上升趋势，尤其是在年轻女性中；然而，这尚未得到外部验证。此外，关于导致这一趋势的因素的数据有限。我们报告了使用国家癌症登记计划数据库（无监测、流行病学和最终结果数据）进行的胰腺癌年龄调整发病率（aIR）的年龄和性别特定时间趋势分析。
计算了 PC 的 aIR、死亡率、年百分比变化和平均年百分比变化（AAPC），并评估了平行性和一致性。在年龄较大（≥55 岁）和年龄较小（<55 岁）的成年人中进行了年龄特异性分析。评估了年轻成年人中基于人口统计学、肿瘤特征和死亡率的 PC 发病率。
2001 年至 2018 年间，共有 454611 例患者被诊断患有 PC，女性（AAPC=1.27%）和男性（AAPC=1.14%）的 aIR 均显著增加，差异无统计学意义（P=0.37）。在年龄较大的成年人中也观察到了类似的结果。然而，在年轻成年人（53051 例；42.9%为女性）中，女性的 aIR 增长幅度大于男性（AAPCs=2.36%，P<0.001 与 0.62%，P=0.62），且趋势不平行（P<0.001），AAPC 差异为 1.74%（P<0.001）。这种 AAPC 差异似乎是由于黑人（2.23%；P<0.001）、腺癌组织病理学亚型（0.89%；P=0.003）和胰头部位（1.64%；P<0.001）aIR 的上升所致。在女性中，PC 死亡率保持不变，但在相应的男性中则有所下降（AAPC 差异=0.54%；P=0.001）。
使用覆盖美国约 64.5%人口的全国性数据，我们对外验证了年轻女性中 PC 的 aIR 迅速上升。2001 年至 2018 年期间，15-34 岁女性和男性之间的发病率趋势差异很大（差异>200%），且没有放缓迹象。
