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

Abstract

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.

Impact of Patient Age on Postoperative Short-Term and Long-Term Outcome after Pancreatic Resection of Pancreatic Ductal Adenocarcinoma

“…Patients under 70 years of age were used as a control group for 70–79- and over 80-year-old patients who had undergone pancreatic resection in curative intention [ 14 ]. Indeed, various studies, especially more recent ones, have found a difference in OS and DSF in younger and older patients after pancreatic resection [ 10 , 28 , 29 , 30 ]. Xu et al evaluated the long-term prognosis of 95 patients older than 70 years with pancreatic adenocarcinoma compared to patients under 70 years of age using propensity score matching.…”

“…Third, the undertreatment of older patients is another influential factor [ 36 ]. Even recent studies in pancreatic cancer patients with primary surgical resection presented lower rates of adjuvant chemotherapy in the elderly [ 28 , 37 ], whereas studies showed that adjuvant chemotherapy is associated with prolonged survival independent of age [ 38 ]. The reasons are, therefore, multifactorial, and one must assume that the patient’s general condition was too weak or they refused adjuvant chemotherapy.…”

Pancreatic adenocarcinoma and aging: understanding the menace for better management

“…Hackner et al [56] Retrospective .004 Xu et al [57] was associated with a longer median survival (17.2 months; 95% confidence interval [CI], 16.1-19.0) compared with those who did not receive adjuvant chemotherapy (12.7 months; 95% CI, 11.8-13.6) in the elderly PDAC patients (80 years or older) and this association was consistent in propensity and subgroup analyses. [58] Besides, further multivariable analysis indicated receipt of adjuvant chemotherapy (hazard ratio [HR], 0.72; 95% CI, 0.65-0.79; P < .001) was associated with a decreased hazard of death in the elderly PDAC patients.…”

Nomograms for Predicting the Risk and Prognosis of Liver Metastases in Pancreatic Cancer: A Population-Based Analysis

“…In our study, we found that the main age group of PCLM patients was between 50 and 74 years. According to the Kaplan–Meier survival analysis, the prognosis of older patients had worse OS compared with younger patients [ 66 , 67 ]. This confirms earlier findings that older patients could be more susceptible to tumor immune escape as their autoimmune capacity decreases [ 68 ].…”