Pancreaticoduodenectomy is justified in a subset of elderly patients with pancreatic ductal adenocarcinoma: A population-based retrospective cohort study of 4,283 patients

Lu, Lixuan; Zhang, Xianbin; Tang, Guanglin; Shang, Yongpeng; Liu, Peng; Wei, Yu‐Shan; Gong, Peng; Ma, Li

doi:10.1016/j.ijsu.2018.03.054

Cited by 16 publications

(9 citation statements)

References 29 publications

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“…13,15 Other series reported that advanced age, comorbidity, body mass index (BMI), tumor markers, resection margin, and adjuvant therapy are also predictors of outcome in PDAC. [15][16][17] Tumor markers like CA19-9 may be elevated in more than 80% of the patients with PDAC, it is usually used as a predictor marker of tumor recurrence after resection and very high levels can be used for diagnosis especially if it was used with elevated carcinoembryonic antigen (CEA). Hartwig et al showed that elevated CA19-9 >400u/ml is a strong predictor of low survival, as seen in our study, but cholestasis can affect the level of CA19-9 and CEA as it is excreted in bile.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Zakaria¹,

Mohamed²,

Alsebaey³

et al. 2018

Int Surg J

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Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection remains the only potentially curative treatment. The aim of the study was to identify the outcome and risk factors affecting survival after pancreaticoduodenectomy (PD) for PDAC.Methods: The patients who underwent PD for PDAC from 2007 to 2015 were retrospectively studied. Cox regression test for multivariate analysis was used for evaluation of prognostic factors for survival.Results: Ninety-four patients underwent PD for PDAC, 20 patients (21.3%) had major postoperative complications. The perioperative mortality was 4.3%. The 1-, 3-, and 5-years survival rates were 74.5%, 38.7%, 23.4, respectively. In univariate analysis the risk factors for survival were; presence of co-morbidity (P=0.03), high preoperative carbohydrate antigen (CA)19-9 > 400U/ml (P=0.02), advanced tumor stage (P=0.03), large tumor diameter >3cm (P=0.01), poorly differentiated tumor (P= 0.02), involved resection margin (P=0.04), and positive lymph nodes in pathology after surgery (P=0.03). In multivariate analysis the independent risk factors for survival were; high preoperative CA 19-9 (P=0.042), tumor size >3cm (P=0.038), poorly differentiated tumor in histopathology (P=0.045).Conclusions: High tumor marker CA19-9, tumor size, and grade are significant risk factors for poor survival after resection of PDAC and should be taken into account in the selection of patients for surgery to improve the outcome.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Zakaria¹,

Mohamed²,

Alsebaey³

et al. 2018

Int Surg J

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“…Several retrospective analyses have evaluated the value of adjuvant chemotherapy in the subset of elderly patients. The latest retrospective cohort research led by Mehtsun et al has found that receipt of adjuvant chemotherapy Hilal et al [51] Retrospective 524 Young: 64 ( Lu et al [52] Retrospective 4283 Young: 64 ( Wu et al [53] Retrospective Satoi et al [55] Retrospective 556 ≥80 2007-2014 Pancreatectomy vs chemotherapy, palliative therapy OS 22.8 vs 18.5 0.64 (0.44-0.93) .020…”

Section: Safety Feasibility and Effect Of Chemotherapy In Elderly Pda...mentioning

confidence: 99%

Pancreatic adenocarcinoma and aging: understanding the menace for better management

Zhou

Jin

Hao

et al. 2023

Journal of Pancreatology

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Pancreatic ductal adenocarcinoma (PDAC) is the leading cause of cancer-related death worldwide. As PDAC is more common in older adults and the population is aging, the incidence of pancreatic adenocarcinoma is expected to increase in the coming years. As a result, the mechanism and clinical management of PDAC in the elderly population is receiving more attention. This review will discuss age-related morphological and pathological changes, clinical management, surgery and adjuvant therapies, and molecular changes in elderly PDAC patients. More research is needed to clarify molecular mechanisms and develop new prevention and treatment strategies for PDAC in elderly patients.

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“…However, it was uncertain whether surgery will benefit the elderly patients. Some researchers suggested that the prognosis in the elderly was poorer than in the younger patients ( 8 , 9 ), while others hold the opposed points of view ( 10 – 12 ). What seems clear, though, is that the incidence of postoperative complications is much higher in the elderly patients ( 13 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Effect of Age in Resected Pancreatic Cancer Patients: A Propensity Score Matching Analysis

Zhang

Han

et al. 2022

Front. Oncol.

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BackgroundWhile the elderly population account for an indispensable proportion in pancreatic ductal adenocarcinoma (PDAC), these patients are underrepresented in clinical trials. Whether surgery offered the same benefit for elderly patients as that for younger cohort and which factors affected long-term outcome of elderly population remained unclear.AimsThis study aims to evaluate long-term prognosis of elderly PDAC patients (≥70 years old) after surgery and to investigate potential prognostic factors.MethodsThis retrospective study included PDAC patients receiving radical resection from January 2012 to July 2019 in Zhongshan Hospital Fudan University. Patients were divided into young (<70) and old groups (≥70). Propensity score matching (PSM) was conducted to eliminate the confounding factors. We investigated potential prognostic factors via Cox proportional hazards model and Kaplan–Meier estimator. Nomogram model and forest plot were constructed to illustrate the prognostic value of age.ResultsA total of 552 PDAC patients who received radical resection were included in this research. Elderly patients showed poorer nutritional status and were less likely to received adjuvant treatment. After matching, although age [hazard ratio (HR)=1.025, 95%CI 0.997–1.054; p=0.083] was not statistically significant in the multivariate cox regression analysis, further survival analysis showed that patients in the old group had poorer overall survival (OS) when compared with young group (p=0.039). Furthermore, reception of adjuvant chemotherapy (HR=0.411, 95%CI 0.201-0.837; p=0.014) was the only independent prognostic factor among elderly patients and could significantly improve OS. Subgroup analysis indicated that age had better prognostic value in PDAC patients with good preoperative nutritional status and relative low tumor burden. Finally, a prognostic prediction model contained age, reception of adjuvant chemotherapy, American Joint Committee on Cancer (AJCC) 8th T and N stage was constructed and presented in nomogram, whose Harrell’s concordance index was 0.7478 (95%CI, 0.6960–0.7996). The calibration curves at 1 and 3 years indicated an optimal conformity between actual and nomogram-predicted survival probability in the PDAC patient who received surgery.ConclusionThe elderly PDAC patients were associated with worse OS survival after radical resection, and the noticeable negative effect of age was observed among PDAC patients with better preoperative nutritional status and less aggressive tumor biology. Adjuvant chemotherapy was essential to improve survival outcome of elderly PDAC patients following radical resection.

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Pancreaticoduodenectomy is justified in a subset of elderly patients with pancreatic ductal adenocarcinoma: A population-based retrospective cohort study of 4,283 patients

Cited by 16 publications

References 29 publications

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Pancreatic adenocarcinoma and aging: understanding the menace for better management

Prognostic Effect of Age in Resected Pancreatic Cancer Patients: A Propensity Score Matching Analysis

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