Risk factors associated with gastroenteropancreatic neuroendocrine tumors in a cohort of 2.3 million Israeli adolescents

• Published in: International journal of cancer 2018-10, Vol.143 (8), p.1876-1883
• Main Authors: Katz, Lior H., Levi, Zohar, Twig, Gilad, Kark, Jeremy D., Leiba, Adi, Derazne, Estela, Liphshiz, Irena, Keinan‐Boker, Lital, Eisenstein, Sapir, Afek, Arnon
• Format: Article
• Language: English
• Subjects: Adolescents; Body mass; body mass index; Cancer; Females; gastroenteropancreatic neuroendocrine tumors; Gender; height; Immigrants; Immigration; Medical research; Neuroendocrine tumors; Pancreas; Rectum; Risk factors; Small intestine; Socioeconomics; Tumors
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.31589

We investigated whether obesity and sociodemographic factors at adolescence are associated with incident gastroenteropancreatic neuroendocrine tumors (GEP‐NET).Our cohort included 2.3 million Israeli adolescents examined at ages 16 to 19 years between 1967 and 2010. The baseline database included sex, country of birth, residential socioeconomic status (SES), body‐mass index (BMI) and height. Participants were followed through linkage with the National Cancer Registry up to 2012. We identified 221 cases of GEP‐NET (66 pancreatic, 52 gastric, 39 rectal, 27 appendiceal, 23 small bowel and 14 colonic). Immigration from the Former Soviet Union (FSU) was associated with the risk of small bowel and rectal NET's, [Hazard Ratio (HR) 4.79, 95% Confidence Interval (CI) 1.37–16.76 and 3.43, 95% CI 1.20–9.83, respectively].Height >75th percentile and BMI ≥ 85th percentile were associated with increased risk of gastric NET (HR 2.25 95% CI 1.14–4.42 and HR 2.38, 95% CI 1.19–4.75, respectively). Female sex was associated with appendiceal NET (HR 2.30, 95% CI 1.06–4.96) while male gender was associated with an increased risk for NET of the small bowel [HR 4.72 (95% CI 1.10–20.41)].In conclusion, our findings suggest different risk factor associations with the various GEP‐NETS: immigrants from the FSU were at increased risk for small bowel and rectal NET; increased height and weight were associated with the risk of gastric NET and females were at increased risk for appendiceal NET. Further focus on the FSU population is indicated in addition to studies verifying the association of BMI and height with gastric NET. What's new? Incidence and prevalence of neuroendocrine tumors (NETs) in the gastrointestinal tract as well as the pancreas are rising but risk factors for this heterogeneous group of cancers are largely unknown. Here the authors studied a large cohort of Israeli adolescents and found that immigrants from the Former Soviet Union were at increased risk for small bowel and rectal NETs. Increased height and weight enhanced the risk of gastric NETs underscoring the need for more detailed studies into the risk factors of individual NETs.