J. E. Ordonez1, C. A. Hester1, H. Zhu1, M. Augustine1, M. R. Porembka1, S. C. Wang1, A. C. Yopp1, J. C. Mansour1, H. J. Zeh1, P. M. Polanco1,2 1University Of Texas Southwestern Medical Center,Division Of Surgical Oncology,Dallas, TX, USA 2Department of Veterans Affairs – North Texas Health Care System,Surgical Oncology,Dallas, TX, USA
Introduction: There is limited research regarding Pancreatic Ductal Adenocarcinoma (PDAC) diagnosed in Early-Onset (EO) patients. EO is defined as cancer diagnosis before the age of 50. We aimed to characterize the clinicopathologic factors and treatment outcomes associated with EO patients compared to late onset (LO) patients and determine the impact of EO PDAC on survival.
Methods: The National Cancer Database was queried to identify EO and LO PDAC patients diagnosed from 2004 to 2013. Demographics, tumor characteristics, treatment regimens, and overall survival (OS) were compared between groups.Chi-square and Fisher’s exact tests were used to compare cohorts. Kaplan-Meier with log-rank univariate analysis was used to analyze survival. Cox proportional hazard regression was used to create a multivariable model.
Results:
207,062 patients were included in the study: 12,137 (5.9%) EO and 194,925 (94.1%) LO patients. EO patients were more likely to present with later stage of disease (Stage III/IV disease, 62.1% vs 55.2%, p <0.001) and larger tumor size (tumor ≥ 4cm, 36.7% vs 32.9 %, p<0.001) compared to those with LO PDAC. LO patients presented with higher Charlson/Deyo comorbidity score (CDCC ≥1, 33.4% vs. 19.1%, p <0.001), and increased proportion of tumors located in the pancreatic head (52.4% vs 50.8%, p=0.002), compared to EO patients. EO patients received more curative intent surgical resection, including surgery alone or with neoadjuvant/adjuvant therapies (24.0% vs 19.2%, p <0.001) and palliative chemoradiation (13.7% vs 10.2% p <0.001) compared to LO patients. LO patients had a significantly higher proportion of patients who received no treatment (40.5% vs 23.3% p <0.001). EO PDAC was associated with improved OS among all PDAC patients (9.0 vs 6.2 months, p<0.001) and surgically resected patients (26.6 vs 24.3 months, p<0.001). EO PDAC was also independently associated with improved OS after adjusting for other significant clinicopathological factors.
Conclusion: In conclusion, EO PDAC comprised 5.9% of all PDAC cases. EO patients presented with features characteristic of more advanced disease, including larger tumors and later stage. EO patients also received higher rates of curative and palliative therapies. Within curatively resected patients, EO patients received higher rates of neoadjuvant and adjuvant therapy. EO PDAC was independently associated with improved OS compared to LO PDAC among all patients and also amongst curatively resected stage matched patients.
