title: Early onset pancreatic cancer: risk factors, presentation and outcome.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  EOPC seems related to active and early smoking but not to familial syndromes. Young patients display aggressive disease but not worse outcome.
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Piciucchi
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Capurso
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Valente
authors.affiliation: Endoscopy Division, Gemelli Hospital, Faculty of Medicine and Surgery, Catholic University of Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Archibugi
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Signoretti
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Stigliano
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Zerboni
authors.affiliation: Oncology Department, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Viola
authors.initials: V
authors.lastname: Barucca
authors.affiliation: General Surgery Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: La Torre
authors.affiliation: General Surgery Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cavallini
authors.affiliation: Endoscopy Division, Gemelli Hospital, Faculty of Medicine and Surgery, Catholic University of Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: Oncology Department, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
authors.affiliation: General Surgery Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ziparo
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy. Electronic address: gianfranco.dellefave@uniroma1.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000368:Aged; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000401:mortality*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Early onset; Family history; Metastasis; Pancreatic cancer; Smoking; Survival