Early onset pancreatic cancer-exploring contemporary treatment and outcomes using real-world data

Abstract

Background: Pancreatic cancer incidence is increasing in younger populations. Differences between early onset pancreatic cancer (EOPC) and later onset pancreatic cancer (LOPC), and how these should inform management warrant exploration in the contemporary setting.

Methods: A prospectively collected multi-site dataset on consecutive pancreatic adenocarcinoma patients was interrogated. Patient, tumour, treatment, and outcome data were extracted for EOPC (≤50 years old) vs LOPC (>50 years old).

Results: Of 1683 patients diagnosed between 2016 and 2022, 112 (6.7%) were EOPC. EOPC more frequently had the tail of pancreas tumours, earlier stage disease, surgical resection, and trended towards increased receipt of chemotherapy in the curative setting compared to LOPC. EOPC more frequently received 1st line chemotherapy, 2nd line chemotherapy, and chemoradiotherapy than LOPC in the palliative setting. Recurrence-free survival was improved for the tail of pancreas EOPC vs LOPC in the resected setting; overall survival was superior for EOPC compared to LOPC across the resected, locally advanced unresectable and metastatic settings.

Conclusions: EOPC remains a small proportion of pancreatic cancer diagnoses. The more favourable outcomes in EOPC suggest these younger patients are overall deriving benefits from increased treatment in the curative setting and increased therapy in the palliative setting.

Fig. 1. Consort diagram and incidence by age at diagnosis.

a Consort diagram. b Incidence by age at diagnosis for those diagnosed between ages 18 and 70.

Fig. 2. Recurrence- and progression-free survival by stage of disease.

a Recurrence-free survival (RFS) for early onset pancreatic cancer (EOPC) patients and later onset pancreatic cancer (LOPC) patients with resected disease. b Progression-free survival (PFS) for EOPC and LOPC patients with locally advanced unresectable pancreatic cancer. c PFS for EOPC and LOPC patients with metastatic pancreatic cancer. (95% CI 95% confidence interval).

Fig. 3. Recurrence-free survival in resected patients by tumour location and type of surgery.

a Recurrence-free survival (RFS) in patients with resected head of pancreas cancers for early onset pancreatic cancer patients (EOPC) vs later onset pancreatic cancer patients (LOPC). b RFS in patients with resected body and tail tumours for EOPC compared to LOPC. c RFS in patients undergoing a Whipples procedures for EOPC vs LOPC. d RFS in patients undergoing distal pancreatectomy for EOPC compared to LOPC. 95% CI 95% confidence interval.

Fig. 4. Overall survival by stage of disease.

a Overall survival (OS) for all early onset pancreatic cancer (EOPC) patients and later onset pancreatic cancer (LOPC) patients. b OS for EOPC and LOPC patients with resected disease. c OS for EOPC and LOPC patients with locally advanced unresectable disease. d OS for EOPC and LOPC patients with metastatic pancreatic cancer. (95% CI 95% confidence interval).