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

Lior H. Katz, Zohar Levi, Gilad Twig, Jeremy D. Kark, Adi Leiba, Estela Derazne, Irena Liphshiz, Lital Keinan-Boker, Sapir Eisenstein, Arnon Afek

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1876-1883
Number of pages8
JournalInternational Journal of Cancer
Issue number8
StatePublished - 15 Oct 2018
Externally publishedYes

Bibliographical note

Funding Information:
1The Gastroenterology Department, Sheba Medical Center, Tel-Hashomer, Israel 2Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel 3The Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel 4The Israel Defense Forces Medical Corps 5The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center 6Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel 7Hebrew University–Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel 8Tel Aviv University, Tel-Aviv, Israel 9Israel Ministry of Health, Tel Hashomer, Israel 10Hebrew University–Hadassah School of Medicine, Jerusalem, Israel 11The general manager office, Tel Hashomer, Israel

Funding Information:
Key words: gastroenteropancreatic neuroendocrine tumors, immigrants, neuroendocrine tumors, body mass index, height Grant sponsor: Israel Cancer Research Fund, New York, USA; Grant sponsor: Environment and Health Fund, Jerusalem, Israel; Grant number: RGA 1002 DOI: 10.1002/ijc.31589 History: Received 17 Mar 2018; Accepted 16 Apr 2018; Online 9 May 2018 Correspondence to: Prof. Zohar Levi, MD, MHA, Head, Early Detection and High risk Clinic, The Gastroenterology Department, Rabin Medical Center, Jabotinsky 39, Petach Tikva, PO39100, Israel, Tel.: 972-3-6977071, E-mail: zohar.levi.gastroenterology@gmail.com

Publisher Copyright:
© 2018 UICC


  • body mass index
  • gastroenteropancreatic neuroendocrine tumors
  • height
  • immigrants
  • neuroendocrine tumors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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