Clinicopathologic Features and Outcomes of Early-Onset Pancreatic Adenocarcinoma in the United States

Background Limited research has been performed regarding pancreatic ductal adenocarcinoma (PDAC) diagnosed in early-onset patients. This study defined early-onset disease as cancer diagnosed before the age of 50 years and aimed to characterize the clinicopathologic factors associated with early- versus late-onset patients. Methods The National Cancer Database was queried to identify early- and late-onset PDAC patients with cancer diagnosed from 2004 to 2013. Patient demographics, tumor characteristics, treatment regimens, and overall survival (OS) were compared between the groups. Results The study enrolled 207,062 patients, including 12,137 early-onset patients (5.9%) and 194,925 late-onset patients (94.1%). The early-onset patients (stage 3 or 4 cancer) were more likely to present with a later stage of disease (62.1% vs. 55.2%; p < 0.001) and to be male (57.1% vs. 50.0%; p < 0.001) than those with late-onset PDAC. The early-onset patients also presented with a lower Charlson/Deyo comorbidity score (80.9% vs. 66.6% had a score of 0; p < 0.001) and received higher rates of treatment (22.8% vs. 40.1% received no treatment, p < 0.001) than the late-onset patients. Furthermore, early-onset PDAC was associated with improved OS among all the PDAC patients (9.2 vs. 6.0 months; p < 0.001) and among the surgically resected patients (27.3 vs. 24.3 months; p < 0.001). Early-onset PDAC also was found to be independently associated with improved OS after adjustment for other significant clinicopathologic factors. Conclusions Despite features suggestive of aggressive tumor biology at presentation, early-onset PDAC was independently associated with better OS than late-onset PDAC among all patients and among curatively resected stage-matched patients.