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

Ordonez, Javier E.; Hester, Caitlin A.; Zhu, Hong; Augustine, Mathew M.; Porembka, Matthew R.; Wang, Sam C.; Yopp, Adam C.; Mansour, John C.; Zeh, Herbert J.; Polanco, Patricio M.

doi:10.1245/s10434-019-08096-y

Cited by 18 publications

(42 citation statements)

References 19 publications

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“…We divided the patient population into two groups based on the age of diagnosis. Those diagnosed with PNET at the age of less than 50 years were classified as YOPNET, and those 50 years or above were classified as typical-onset PNET (TOPNET) [ 3 , 30 , 31 , 32 ]. In addition, the age at presentation was categorized as five groups <35, 35–49, 50–64, 65–79, ≥80 to assess the survival trends.…”

Section: Methodsmentioning

confidence: 99%

“…We used patient demographics (sex (male, female), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanics, other), Charlson–Deyo Score (0–2+), facility type (academic, non-academic, other), facility location (New England, Middle Atlantic, South Atlantic, East North Central, East South Central, West North Central, West South Central, Mountain, Pacific), socioeconomic status (rurality (metropolitan, non-metropolitan), education level (rates of patients without high school level ≥21%, 13–20.9%, 7–12.9%, <7%), median income quartiles (<USD 38,000, USD 38,000–USD 47,999, USD 48,000–USD 62,999, >USD 63,000), insurance status (uninsured, private insurance, government insurance), travel distance to treatment facility (<12.5, 12.5–49.9, ≥50 miles)), tumor characteristics (primary site (head, body/tail, other), NCDB analytic stage group (I-IV), pathological grade (I-IV) [ 2 , 28 ], tumor size (<2, 2–4, >4 cm), nodal status (negative, positive), and treatments (radiotherapy (yes, no), and chemotherapy (yes, no)) [ 27 , 30 ]. Travel distance was defined using great circle distance, which calculates the distance between the patient’s residence and the reporting facility, using the geographic centroid of zip codes [ 33 ].…”

Section: Methodsmentioning

confidence: 99%

“…NCDB analytic stage is the TNM American Joint Committee on Cancer (AJCC) pathological stage group, but it can use the TNM AJCC clinical stage group when the pathological stage is not available [ 34 ]. We stratified the stage as I-II (early), and III-IV (advanced) [ 30 ]. The Charlso–Deyo score shows comorbid conditions, which contains 19 different diseases, and each disease has a different score between 1 and 6 [ 35 ].…”

Section: Methodsmentioning

confidence: 99%

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Distinct Clinical Characteristics in Young-Onset Pancreatic Neuroendocrine Tumor

Goksu

Özer

Kazmi

et al. 2020

Cancers

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Background: We aimed to study the effect of socioeconomic differences and molecular characteristics on survival in patients with young-onset pancreatic neuroendocrine tumors (YOPNET) and typical-onset PNET (TOPNET). Methods: We identified the patients with YOPNET (<50 years) and TOPNET (≥50 years) who underwent definitive surgery diagnosed between 2004 and 2016 using the National Cancer Database. We evaluated overall survival (OS) using the Kaplan–Meier and Cox regression methods before and after propensity score matching. A publicly available genomic dataset was used to compare mutation frequencies among the two groups. Results: A total of 6259 patients with PNET were included, of which 27% were YOPNET. Patients with YOPNET were more likely to be Black, Hispanic, female, and have private insurance versus patients with TOPNET (all p < 0.001). Patients with YOPNET had a lower comorbidity score, but higher stage and tumor size (all p < 0.001). YOPNET was associated with a greater improved OS than TOPNET before and after propensity score matching (p < 0.001). On multivariable analysis, this survival difference persisted for YOPNET as an independent prognostic factor (unmatched p = 0.008; matched p = 0.01). For genomic analysis, patients with YOPNET had a lower rate of multiple endocrine neoplasia type-1 (MEN-1) mutation than patients with TOPNET (26% vs. 56%, p < 0.001). Conclusions: YOPNET represents a disease with distinct clinical features. Patients with YOPNET who underwent definitive surgery had better OS than patients with TOPNET despite having higher stage and tumor size. YOPNET also had lower rate of MEN-1 mutation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Distinct Clinical Characteristics in Young-Onset Pancreatic Neuroendocrine Tumor

Goksu

Özer

Kazmi

et al. 2020

Cancers

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“…Pancreatic cancer (PC) is a leading cause of cancer‐related mortality and is estimated to have resulted in 47,050 deaths in 2020 alone 1 . Although PC is classically considered a disease of the elderly, early‐onset pancreatic cancer (EOPC), defined as PC diagnosed before the age of 45 to 55 years, has been increasing with respect to older onset disease 2‐4 . Although the risk factors for EOPC are similar to those for average‐age‐onset pancreatic cancer (AOPC), including obesity, smoking, and alcohol use, studies suggest that patients with EOPC may present with distinctive clinical, pathologic, and genomic features, which may affect prognosis 4‐11 …”

Section: Introductionmentioning

confidence: 99%

Treatment patterns and survival in patients with early‐onset pancreatic cancer

Saadat

Chou

Gönen

et al. 2021

Cancer

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Background Pancreatic cancer is uncommon in patients younger than 50 years, although its incidence is increasing. This study characterizes treatment utilization for early‐onset pancreatic cancer (EOPC) versus average‐age‐onset pancreatic cancer (AOPC) and identifies factors associated with failure to receive treatment. Methods The National Cancer Data Base (NCDB) was queried for patients with EOPC (age < 50 years) or AOPC (age ≥ 50 years) from 2004 to 2016. Multinomial regression was used to compare utilization (single modality vs multimodal treatment with or without surgery vs no treatment) between EOPC and AOPC. Kaplan‐Meier methods were used to estimate overall survival (OS). Results Of 248,634 patients, 15,710 (6.3%) had EOPC. There were more male patients (56% vs 50%), non‐White patients, and privately insured patients (61% vs 30%) with EOPC versus AOPC, without notable differences in clinical stage distribution. Patients with EOPC received more chemotherapy (38% vs 29%), surgery (9% vs 6.9%), chemoradiation (12% vs 9.2%), and multimodal treatment (21% vs 15%). The odds of receiving multimodal curative therapy were significantly higher for patients with EOPC versus patients with AOPC after adjustments for confounders (odds ratio, 3.89; 95% confidence interval [CI], 3.66‐4.15; P < .001). Nineteen percent of patients with EOPC, in contrast to 39% of patients with AOPC, received no treatment. Patients with AOPC more frequently declined chemotherapy (15% vs 9.5%). One‐year OS was higher for EOPC versus AOPC across each stage (0/I/II, 72% [95% CI, 71%‐74%] vs 53% [95% CI, 53%‐54%]; III, 48% [95% CI, 45%‐50%] vs 38% [95% CI, 37%‐38%]; IV, 25% [95% CI, 24%‐26%] vs 15% [95% CI, 15%‐15%]) and treated patients (0/I/II, 75% [95% CI, 74%‐77%] vs 64% [95% CI, 63%‐64%]; III, 51% [95% CI, 49%‐54%] vs 47% [95% CI, 47%‐48%]; IV, 29% [95% CI, 28%‐31%] vs 23% [95% CI, 23%‐24%]). Conclusions Patients with EOPC receive more oncologic therapy than patients with AOPC, although the intensity, type, and duration of chemotherapy are not available in the NCDB; however, 19% and 39%, respectively, receive no therapy. Underutilization may explain suboptimal oncologic outcomes. Efforts to improve access and treatment utilization in all age groups are warranted.

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“…The risk score does not always increase with age in our nomogram. Previous research indicated that young cancer patients suffered a higher risk of lymph node metastasis [27][28][29], which may be the reason why the risk score of PDAC patients under 50 is higher than that of ones aged 51-60. Limitations of this study include: (1) the use of retrospective data; (2) detailed treatment information for included patients were not recorded in the SEER cohort, and we cannot investigate specific options, including R0 or not, preoperative or postoperative chemotherapy in the survival of PDAC patients; (3) other important factors, such as proximity/involvement of major vascular structures, CA 19-9, and patient comorbidities should also be minded.…”

Section: Discussionmentioning

confidence: 98%

A novel risk-scoring system conducing to chemotherapy decision for patients with pancreatic ductal adenocarcinoma after pancreatectomy

Li¹,

Tian²,

Zhou³

et al. 2021

J. Cancer

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Background: Chemotherapy is suggested to use in all stages of pancreatic cancer. Is it reasonable to recommend chemotherapy for all PDAC patients? It is necessary to distinguish low-risk PDAC patients underwent pancreatectomy, who may not lose survival time due to missed chemotherapy and not need to endure pain, nausea, tiredness, drowsiness, and breath shortness caused by chemotherapy. Methods: Nomograms were constructed with basis from the multivariate Cox regression analysis. X-tile software was utilized to perform risk stratification. Survival curves were used to display the effect of chemotherapy in different risk-stratification. Results: All of the significant variables were used to create the nomograms for overall survival (OS). The total risk score of each patient was calculated by summing the scores related to each variable. X-tile software was utilized to classify patients into high-risk (score >283), median-risk (197

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

Cited by 18 publications

References 19 publications

Distinct Clinical Characteristics in Young-Onset Pancreatic Neuroendocrine Tumor

Distinct Clinical Characteristics in Young-Onset Pancreatic Neuroendocrine Tumor

Treatment patterns and survival in patients with early‐onset pancreatic cancer

A novel risk-scoring system conducing to chemotherapy decision for patients with pancreatic ductal adenocarcinoma after pancreatectomy

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