Early-Onset Pancreatic Cancer: Practices and Outcomes in an International Dual-Center Study

Introduction Early-onset pancreatic cancer (EOPC), defined as age≤45 years at diagnosis, accounts for 3% of all pancreatic cancer cases. Although differences in tumor biology have been suggested, clinical features and oncologic outcomes of EOPC are largely unknown and specific treatment recommendations are lacking due to the rarity of the condition.

Aims To investigate the clinical features and oncologic outcomes of EOPC.

Methods In a dual-center study, all EOPC patients undergoing resection between 2002 and 2018 were identified from the Heidelberg University Hospital (HUH) and Johns Hopkins University (JHU) prospectively-maintained registries. Median overall survival (OS) and recurrence-free survival (RFS) were analyzed. Prognostic factors of median OS and RFS were identified using univariable and multivariable cox regression analyses.

Results The final cohort included 164 patients with EOPC, of which 136 (82.9%) had pancreatic ductal adenocarcinoma (PDAC), 17 (10.4%) cancer arising from IPMN and MCN (n=1) and 8 (4.9%) adenosquamous carcinoma. 20 (12.1%) patients presented with stage I, 42 (25.6%) with stage II, 75 (45.7%) with stage III, and 22 (13.4%) with oligometastatic stage IV disease. Most patients underwent upfront resection (n=113, 68.9%), while 51 (31.1%) of patients received preoperative treatment. Preoperative chemotherapy and chemoradiation were administered to 47 (28.7%) and 25 (15.2%) patients, while 109 (66.5%) received adjuvant chemotherapy and 24 (22.0%) adjuvant chemoradiation. Median OS and RFS of the entire cohort were 26.0 months and 12.4 months, respectively (no difference between centers). Stage-specific median survival was 70.6, 41.8, 23.8, and 16.9 months for stage I, II, III, and IV, respectively. R1 resection and stage III and IV tumors were independently associated with shorter OS and RFS. The application of preoperative chemotherapy did not differ between both centers, but preoperative radiation was significantly more frequently administered at JHU. Even when adjusting for tumor stage, upfront surgery vs. preoperative treatment was not associated with OS or RFS.

Conclusions Despite frequently presenting with advanced disease, oncologic outcomes in EOPC patients are satisfactory even in locally advanced cancers, justifying aggressive treatment approaches. Further research is needed to tailor current guidelines concerning the surgical treatment of pancreatic cancer to this rare patient population.

Publication History

Article published online:
19 August 2022