Early onset pancreatic cancer: risk factors, presentation and outcome

Pancreatology. Mar-Apr 2015;15(2):151-5. doi: 10.1016/j.pan.2015.01.013. Epub 2015 Feb 12.

Abstract

Background: About 10% of pancreatic cancer patients are aged ≤50 at diagnosis and defined as Early Onset Pancreatic Cancer (EOPC). There is limited information regarding risk factors for EOPC occurrence and their outcome.

Aim: To investigate risk factors, presentation features and outcome of EOPC patients.

Methods: Consecutive, histologically confirmed, pancreatic cancer patients enrolled. Data regarding environmental and genetic risk factors, clinical and pathological information, treatment and survival were recorded. EOPC patients (aged ≤50 at diagnosis) were compared to older subjects.

Results: Twenty-five of 293 patients (8.5%) had EOPC. There was no difference regarding sex distribution, medical conditions and alcohol intake between EOPC and older subjects. EOPC patients were more frequently current smokers (56% vs 28% p = 0.001) and started smoking at a significantly lower mean age (19.8 years, 95%CI 16.7-22.9) as compared to older patients (26.1, 95%CI 24.2-28) (p = 0.001). Current smoking (OR 7.5; 95%CI 1.8-30; p = 0.004) and age at smoking initiation (OR 0.8 for every increasing year; 95%CI 0.7-0.9; p = 0.01) were significant and independent risk factors for diagnosis of EOPC. There were no differences regarding genetic syndromes and pancreatic cancer family history. EOCP presented less frequently with jaundice (16% vs 44%, p = 0.006) and had a higher rate of unresectable disease, albeit not significantly (84% vs 68%, p = 0.1). EOPC patients were more frequently fit for surgery or chemotherapy than their counterpart, resulting in similar stage-specific survival probability.

Conclusion: EOPC seems related to active and early smoking but not to familial syndromes. Young patients display aggressive disease but not worse outcome.

Keywords: Early onset; Family history; Metastasis; Pancreatic cancer; Smoking; Survival.

MeSH terms

  • Adolescent
  • Age of Onset
  • Aged
  • Delayed Diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Pancreatic Neoplasms / epidemiology
  • Pancreatic Neoplasms / genetics
  • Pancreatic Neoplasms / mortality*
  • Risk Factors
  • Smoking / adverse effects
  • Survival Analysis
  • Treatment Outcome
  • Young Adult