Prognostic impact of Geriatric 8 and comprehensive geriatric assessment in older patients with advanced pancreatic ductal adenocarcinoma

Abstract

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis, particularly in older patients (≥70 years), who represent an increasing proportion of cases. However, this population is underrepresented in clinical trials. This study aimed to evaluate the prognostic impact of the Geriatric 8 (G8) screening tool and the comprehensive geriatric assessment (CGA) in older patients with advanced PDAC.

Materials and methods: We conducted a retrospective observational study of patients aged ≥70 years with locally advanced or metastatic PDAC treated at Fondazione Policlinico Gemelli IRCCS between January 2018 and August 2023. Clinical, demographic, and treatment data were extracted through structured and unstructured data mining. All patients underwent G8 screening at the start of first-line therapy; if G8 was ≤14, patients could have received CGA. Primary endpoints were progression-free survival (PFS) and overall survival (OS), analyzed through Kaplan-Meier estimates and Cox regression models.

Results: Of 268 eligible older patients, 210 (78.4 %) received first-line chemotherapy. Most received gemcitabine plus nab-paclitaxel (58.1 %). Median PFS and OS were 6.5 (95 % CI: 5.7-7.3) and 9.9 months (95 % CI: 9.1-11.7), respectively. Baseline Geriatric 8 score was ≤14 in 149 out of 210 (70.9 %) patients and ≥ 15 in 61 out of 210 (29.1 %). A baseline G8 score ≥ 15 was significantly associated with higher PFS (7.9 vs. 5.3 months, HR 0.57, p = 0.001) and OS (16.6 vs. 7.8 months, HR 0.39, p < 0.001), both at univariate and multivariate analyses. Among the 149 patients with a baseline G8 ≤ 14, 97 (65.1 %) were referred for CGA, and 60 (40.3 % of the overall G8 ≤ 14 population) completed the assessment. No difference in mPFS (p = 0.28) nor in mOS (p = 0.25) emerged according to CGA assessment. However, the 12-month survival rate was higher in patients who underwent CGA (31.8 %) compared with those who did not (14.2 %).

Discussion: First-line chemotherapy provides particular clinical benefit to older adults with PDAC with higher G8 scores, though benefit was observed across the broader cohort. The G8 score was a strong independent prognostic tool for treatment response and survival.

Keywords: CGA; Geriatric 8; advanced pancreatic cancer; first-line therapy; older patients.