Comparison of characteristics and outcomes of young‐onset versus average onset pancreatico‐biliary adenocarcinoma

Abstract

Background Young‐onset gastrointestinal malignancies appear to be increasing in incidence. There are limited data on young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). Methods The study comprised patients with PBA (pancreatic adenocarcinoma, intra‐, and extra‐hepatic cholangiocarcinoma) and included in the National Cancer Database (NCDB) between 2004 and 2017. YO‐PBA was defined as a diagnosis at age less than 50 years. Logistic regression to assess factors associated with YO‐PBA status, and cox proportional hazards modeling to associate relevant factors with overall survival was performed. Results The study cohort comprised 360,764 patients, with 20,822 (5.8%) YO‐PBA. YO‐PBA was associated with ( p ‐values<0.0001 for all): male sex (6.3% YO‐male out of all male patients vs. 5.2% YO‐female, OR 1.29, 95% CI 1.25–1.33), Black race (7.9% YO‐Black vs. 5.0% YO‐White, OR 1.72, 95% CI 1.64–1.80), lower income (6.4% YO‐lowest household income based group vs. 5.5% highest, OR 1.08, 95% CI 1.03–1.13). YO‐PBA were more likely to present with stage‐IV disease (6.4% YO‐Stage IV of all stage IV vs. 5.4% YO‐Stage I–III, OR 1.25, 95% CI 1.21–1.29 p ‐value < 0.0001). Factors associated with overall survival (OS) in non‐operable patients included—sex ‐ male vs. female, HR 1.12 (95% CI 1.08–1.15); race ‐ Black vs. White, HR 1.23 (95% CI 1.06–1.42); income group ‐ lowest vs. highest, HR 1.33 (95% CI 1.27–1.39), and treatment center type ‐ academic vs. nonacademic center, HR 0.87 (95% CI 0.85–0.90). Conclusions Socioeconomic factors significantly impact incidence and outcomes for young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). More work is needed to help understand the mechanisms involved while addressing the disparities.

Epidemiologic trends and survival of early-onset gastroenteropancreatic neuroendocrine neoplasms

“…Given the prevalence of early-onset cancer and the extension of lifespan, heightened attention must be paid to early-onset cancers (22)(23)(24). The incidence of GEP-NENs has been increasing for decades worldwide (20).…”

Changes over time in the course of advanced pancreatic cancer treatment with systemic chemotherapy: a pooled analysis of five clinical trials from two decades of the German AIO study group

“…Details on trial designs, patient characteristics, study treatments, statistical assumptions, and outcome parameters can be found in Table 1 and Supplementary Table S1 , available at https://doi.org/10.1016/j.esmoop.2024.102944 , and the published original reports. 12 , 15 , 16 , 17 , 18 , 19 The overall recruiting period for these five studies was from December 1997 to January 2017. All analyses were carried out based on the respective intention-to-treat population.…”

“… 11 In addition, very little is known about whether the disease of younger patients with PDAC differs pathophysiologically from that of older patients. 12 Two recent publications have delved deeper into the hypothesis suggesting that younger patients with pancreatic and gastrointestinal cancers may exhibit distinct pathogenetic patterns in their tumors. Consequently, they might require more personalized treatment options.…”

Molecular Differences With Therapeutic Implications in Early-Onset Compared With Average-Onset Biliary Tract Cancers

“…4,5 While most patients affected by BTC belong to older age groups (defined as 50 years or older), a disturbing trend is the increasing incidence of early-onset BTC (eoBTC; defined as cancers in patients younger than 50 years). [6][7][8] BTC, particularly the intrahepatic BTC and gallbladder cancers, has been identified as the cancer types with the highest rates of increase in incidence for early-onset cancers with annual percentage changes of 8% and 2%, respectively. 8 Several unique clinical characteristics such as advanced stage at presentation and refractoriness to chemotherapy have been described in eoBTC.…”

“…8 Several unique clinical characteristics such as advanced stage at presentation and refractoriness to chemotherapy have been described in eoBTC. 6,9 BTC, up to 40%, do harbor targetable alterations, and molecular profiling for all patients is currently recommended by the National Comprehensive Cancer Network (category 2A). [12][13][14][15][16] However, most studies and clinical trials in BTC are based on the average age of onset.…”