Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Int J Surg. 2024 Apr 1;110(4):1929-1940. doi: 10.1097/JS9.0000000000001054.
Early-onset pancreatic cancer (EOPC) in younger populations (age ≤50 years) is likely to be a more aggressive phenotype characterized by poor differentiation. The emerging analysis of the global burden of EOPC is limited and outdated.
To systematically investigate the burden and trend of EOPC based on global populations.
In this systematic analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, the authors present the number of cases, age-standardized rates (ASRs) per 100 000 population, and risk factors for 204 countries and territories. The average annual percentage changes (AAPCs) for the incidence, mortality, and disability-adjusted life-years (DALYs) of EOPC were calculated using joinpoint regression analysis.
According to the GBD 2019 estimates, there were 36 852 new cases of EOPC and 32 004 related deaths. East Asia had the highest number of cases, with 11 401 incidences and 10 149 deaths. The ASRs were 0.94 per 100 000 individuals for incidence and 0.81 per 100 000 for mortality. From 1990 to 2019, the age-standardized incidence increased by 46.9%, mortality increased by 44.6%, and DALYs increased by 41.9% globally. In trend analysis, the global incidence (AAPC, 1.26), mortality (AAPC, 1.24), and DALYs (AAPC, 1.25) of EOPC showed an increasing pattern. The ASRs of incidence, mortality, and DALYs of EOPC in Africa, America, and Asia exhibited a continuous upward trend, while the trend in Europe was fluctuating. Asian males exhibited the fastest growth in incidence (AAPC, 2.15) and mortality (AAPC, 2.13), whereas males in the Americas experienced the slowest increase in new cases (AAPC, 0.72) and deaths (AAPC, 0.67). A certain proportion of EOPC DALYs were attributable to known risk factors: tobacco smoking (13.3%), high BMI, 5.6%, and high fasting plasma glucose 3.2%. Integrating the socio-demographic index (SDI), ASRs of incidence and mortality initially increased with rising SDI, reaching a peak in central Europe (1.5 per 100 000 <ASRs <2.0 per 100 000), and decreased with further increase in SDI in 2019.
The findings offer valuable insights into the global distribution and magnitude of the EOPC burden. The burden is increasing at a rapid pace worldwide, particularly in Asia, and is notably high in central and eastern Europe. This highlights the need for additional preventive control efforts targeting high-risk populations.
在年轻人群体（年龄≤50 岁）中，早发性胰腺癌（EOPC）可能是一种更具侵袭性的表型，其特征为分化不良。目前对于 EOPC 全球负担的新兴分析还很有限且已过时。
基于全球人群，系统地研究 EOPC 的负担和趋势。
在这项基于全球疾病、伤害和危险因素研究（GBD）2019 年的系统分析中，作者呈现了 204 个国家和地区的病例数、每 10 万人标准化发病率（ASR）以及风险因素。使用 joinpoint 回归分析计算 EOPC 发病率、死亡率和伤残调整生命年（DALY）的年平均百分比变化（AAPC）。
根据 GBD 2019 年的估计，EOPC 新发病例数为 36852 例，相关死亡人数为 32004 例。东亚的病例数最多，有 11401 例发病和 10149 例死亡。发病率的 ASR 为 0.94/10 万，死亡率的 ASR 为 0.81/10 万。1990 年至 2019 年间，全球发病率的年龄标准化增长率为 46.9%，死亡率的增长率为 44.6%，DALY 的增长率为 41.9%。在趋势分析中，EOPC 的全球发病率（AAPC，1.26）、死亡率（AAPC，1.24）和 DALY（AAPC，1.25）均呈上升趋势。非洲、美洲和亚洲的 EOPC 发病率、死亡率和 DALY 的 ASR 呈持续上升趋势，而欧洲的趋势则波动不定。亚洲男性的发病率（AAPC，2.15）和死亡率（AAPC，2.13）增长最快，而美洲男性的新发病例（AAPC，0.72）和死亡病例（AAPC，0.67）增长最慢。一定比例的 EOPC DALY 归因于已知的风险因素：吸烟（13.3%）、高 BMI（5.6%）和高空腹血糖（3.2%）。综合社会人口指数（SDI）后，发病率和死亡率的 ASR 最初随 SDI 的升高而升高，在中欧达到峰值（1.5 至 2.0/10 万），并在 2019 年随 SDI 的进一步升高而降低。
这些发现提供了关于 EOPC 全球负担的分布和程度的有价值的见解。全球 EOPC 的负担正在迅速增加，尤其是在亚洲，而中欧和东欧的负担尤其高。这凸显了需要针对高危人群开展更多的预防控制工作。
