P2116 - Very Early and Early-Onset of Pancreatic Adenocarcinoma; An Insight from National Cancer Database 2004-2016

Navkiran Randhawa, DO¹, Maharaj Singh, PhD², Christina Wu, MD³, Vaishali Patel, MD³, Steven Keilin, MD³, Field Willingham, MD, MPH³, Saurabh Chawla, MD, FACG^3
1Franciscan St. James Hospital, Olympia Fields, IL; ²Advocate Aurora Research Institute and Marquette University, Milwaukee, WI; ³Emory University School of Medicine, Atlanta, GA

Introduction: Pancreatic cancer is expected to be the second most common cause of cancer related death in the United States by 2030. As the incidence of pancreatic cancer increases, the rate at which younger patients are diagnosed also increases. The purpose of this study is to analyze the epidemiology, mortality rate, and treatment trends of very early onset and early onset pancreatic ductal adenocarcinoma (PDAC) using the National Cancer Database (NCBD)

Methods: The NCDB was used to identify 324,500 patients with PDAC from 2004 through 2016. Data was characterized according to different age groups. Very early-onset PDAC (VE-PDAC) was described as < 40 years old, early onset PDAC included ages 40 to 50 (E-PDAC) and late onset PDAC described patients older than 50 (L-PDAC) The data was analyzed using cox proportional hazard regression analysis (CPHR).

Results: The number of VE-PDAC and E-PDAC patients steadily increased from 2004-2016. However, it continued to constitute < 10% of all patients with PDAC. The proportion of minorities in the younger cohorts was significantly higher than the older cohort (35.8% in VE-PDAC, 28.9% in E-PDAC and 19.7% in L-PDAC). Similar to L-PDAC, most younger patients present with advanced disease. 60% of the VE-PDAC cohort presented in stage 4 compared to 55% of E-PDAC and 51% of L-PDAC. After controlling for other variables, the CPHR revealed VE-PDAC (HR=0.72) and E- PDAC (HR=0.88) patients had better survival compared to L-PDAC (Table 1). Of those receiving treatment, most patients in all cohorts were more likely to undergo chemotherapy before surgery. VE-PDAC patients were more likely to be treated with surgery alone (35.9%) compared the E-PDAC (17.7%) and L-PDAC cohorts (25.4%). VE-PDAC and E-PDAC patients had higher survival with surgery alone compared to L-PDAC (Figure 1).

Discussion: Our study reveals that VE-PDAC and E-PDAC constitute < 10% of all patients with PDAC. Young patients are more likely to be minorities, present at a similar stage of disease and yet still have better survival after controlling other variables compared to L-PDAC patients. While most patients undergoing surgery received chemotherapy before surgery, VE PDAC patients were more likely to undergo surgery alone. VE and E-PDAC patients treated with surgery alone had higher survival estimates than other treatments. Further studies are needed to examine differences in biological behavior in PDAC in younger cohorts to improve early recognition and identify novel targets for therapy.




Disclosures:


Navkiran Randhawa, DO¹, Maharaj Singh, PhD², Christina Wu, MD³, Vaishali Patel, MD³, Steven Keilin, MD³, Field Willingham, MD, MPH³, Saurabh Chawla, MD, FACG³. P2116 - Very Early and Early-Onset of Pancreatic Adenocarcinoma; An Insight from National Cancer Database 2004-2016, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.