Abstract
Background
Pancreatic cancer incidence is increasing in younger populations. Differences between early onset pancreatic cancer (EOPC) and later onset pancreatic cancer (LOPC), and how these should inform management warrant exploration in the contemporary setting.
Methods
A prospectively collected multi-site dataset on consecutive pancreatic adenocarcinoma patients was interrogated. Patient, tumour, treatment, and outcome data were extracted for EOPC (≤50 years old) vs LOPC (>50 years old).
Results
Of 1683 patients diagnosed between 2016 and 2022, 112 (6.7%) were EOPC. EOPC more frequently had the tail of pancreas tumours, earlier stage disease, surgical resection, and trended towards increased receipt of chemotherapy in the curative setting compared to LOPC. EOPC more frequently received 1st line chemotherapy, 2nd line chemotherapy, and chemoradiotherapy than LOPC in the palliative setting. Recurrence-free survival was improved for the tail of pancreas EOPC vs LOPC in the resected setting; overall survival was superior for EOPC compared to LOPC across the resected, locally advanced unresectable and metastatic settings.
Conclusions
EOPC remains a small proportion of pancreatic cancer diagnoses. The more favourable outcomes in EOPC suggest these younger patients are overall deriving benefits from increased treatment in the curative setting and increased therapy in the palliative setting.
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Data availability
The data underlying this study will be shared on reasonable request to the corresponding author.
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Acknowledgements
Michael Harold and Julie Johns at WEHI and BioGrid Australia for data collection and collation. Joanna Oakley for editorial assistance. Eastern Health Research Foundation—APH Philanthropic Foundation Research and Innovation Grant 2020. Epworth Medical Foundation. Poster presentation at the American Society of Clinical Oncology (ASCO) 2022 Gastrointestinal Cancers Symposium, January 20–22 2022 [26].
Funding
The PURPLE translational registry receives philanthropic support from the Hemstritch Foundation and the Pancare Foundation. BL is the recipient of the Hemstritch Centenary Fellowship.
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SM was involved in conception, design, analysis, drafting and revision. SM had full access to the data and holds final responsibility for the decision to submit for publication. LL acquired the data, was involved in the design, revised the manuscript and approved the final version. YHT interpreted results, revised the manuscript and approved the final version. SA acquired data, revised the manuscript and approved the final version. MM acquired data, revised the manuscript and approved the final version. SAM acquired data, revised the manuscript and approved the final version. BT acquired data, revised the manuscript and approved the final version. BJ acquired data, revised the manuscript and approved the final version. BK acquired data, revised the manuscript and approved the final version. AF acquired data, revised the manuscript and approved the final version. MN acquired data, revised the manuscript and approved the final version. VA acquired data, revised the manuscript and approved the final version. JS acquired data, revised the manuscript and approved the final version. KC acquired data, revised the manuscript and approved the final version. SP acquired data, was involved in the design, revised the manuscript and approved the final version. CEC acquired data, revised the manuscript and approved the final version. RZ acquired data, revised the manuscript and approved the final version. RW acquired data, revised the manuscript and approved the final version. PG was involved in the conception, design, revised the manuscript and approved the final version. BL was involved in conception, design, revised the manuscript and approved the final version.
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The (Pancreatic Cancer: Understanding Routine Practice and Lifting End Results (PURPLE). A Prospective Pancreatic Cancer Clinical Registry) PURPLE registry has ethics approval through the Melbourne Human Research Ethics Committee (Ethics approval number 2016.200), is listed on the Australia New Zealand Clinical Trials Registry, registration number ACTRN12617001474347, and operates under a waiver of consent. The Human Research Ethics Committee at each of the participating sites approved this study (HREC/17/MH/38). The study was performed in accordance with the Declaration of Helsinki.
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Mendis, S., Lipton, L., To, Y.H. et al. Early onset pancreatic cancer—exploring contemporary treatment and outcomes using real-world data. Br J Cancer (2024). https://doi.org/10.1038/s41416-024-02619-5
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DOI: https://doi.org/10.1038/s41416-024-02619-5