Volume 2(1); Pages: 71-77, 2022 | DOI: 10.21873/cdp.10078
ALI ABBASZADEH KASBI, MOHAMMED ALI ASHARY, MIZBA BAKSH, SAMUEL NUSSBAUM, KRISTOPHER ATTWOOD, EMMANUEL GABRIEL
ALI ABBASZADEH KASBI, MOHAMMED ALI ASHARY, MIZBA BAKSH, SAMUEL NUSSBAUM, KRISTOPHER ATTWOOD and EMMANUEL GABRIEL
Department of Surgery, Section of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, U.S.A.
Correspondence to: Ali Abbaszadeh Kasbi, MD, Department of Surgery, Section of Surgical Oncology, Mayo Clinic Florida, FL, U.S.A. Tel: +1 9049532523, e-mail: firstname.lastname@example.org
Received November 10, 2021 | Revised December 2, 2021 | Accepted December 4, 2021
Background/Aim: Pancreatic cancer has a very poor prognosis, though outcomes based on age are not well characterized. The aim of current study was to analyze the survival of patients with pancreatic cancer based on age. Patients and Methods: Using National Cancer Data Base (NCDB), we determined survival outcome based on age among patients with pancreatic cancer. Results: A total of 423,482 patients between 2004 and 2017 were included in the study. Patients aged between 18 and 40-years-old had the worst 3-year survival rate among stage 1 disease. Conversely, patients over 65-years-old had the worst 3-year survival rate and presented with more advanced disease (clinical stages 3 and 4). Conclusion: Older patients with more advanced disease had worse survival.
Despite recent advances in the diagnosis and treatment of pancreatic cancer, this malignancy still has a very poor prognosis (1). Currently, it is the 4th leading cause of cancer-related death in the US and is predicted to become the second leading cause of cancer death by 2030. The incidence of pancreatic cancer is 12.9 per 100,000 people, with an estimated 60,430 new cases in 2021 (1, 2). Important factors in predicting survival for patients with pancreatic cancer include stage and response to multimodal intervention, consisting of chemotherapy, radiation and/or surgery. Accordingly, the 5-year survival of patients who are candidates to undergo treatment for pancreatic cancer can substantially increase (3-5). However, not all patients can complete multimodal therapy because of older age or complications/recovery from surgery. In some cases, neoadjuvant chemotherapy may be better tolerated, can potentially decrease surgery-related complications, and may be effective in converting unresectable tumors into resectable ones (6). Other important factors related to survival are socioeconomic and sociodemographic disparities among patients with pancreatic cancer. Many studies have demonstrated that not only the incidence of pancreatic cancer among African-American patients is higher than whites, but also the mortality is higher (7-9). In addition, some studies have demonstrated that in both genders, mortality of older patients with pancreatic cancer is significantly higher than that of younger peers (9, 10). To further investigate the relationship between age and pancreatic cancer, we utilized National Cancer Data Base (NCDB) to study patients with pancreatic carcinoma and characterize age-based outcomes.
Patients. We conducted a retrospective study between 2004 and 2017 using the National Cancer Data Base (NCDB). The NCDB is a hospital-based cancer registry and joint project of the Commission on Cancer sponsored by both the American College of Surgeons and the American Cancer Society, which represents 70% of all newly diagnosed cancer cases in the US annually. Institutional Review Board approval was not required for the study.
The histology codes for adenocarcinoma (81403), duct cell carcinoma (85003), and islet cell carcinoma (81503) were based on the ICD-03/WHO 2008 classification. The primary site code for head of pancreas (C25.0), body of pancreas (C25.1), tail of pancreas (C25.2), pancreatic duct (C25.3), islets of Langerhans (C25.4), and other lesions of pancreas (C25.7, C25.8, and C25.9) were also based on the ICD-03/WHO 2008 classification.
Patients with pancreatic cancer from all stages, as per the American Joint Committee on Cancer (AJCC 6th and 7th edition) guidelines, were included. Patients with unknown stage were excluded from the analysis. Additional variables included treatment facility type, patients socioeconomical and demographic status, Charlson-Deyo Comorbidity (CDC) score, characteristics of tumor, history of radiotherapy and systemic therapies, surgical intervention, and survival.
Statistical analysis. To evaluate age-related survival outcomes, we divided patients into 3 groups based on their age (group I: 18-40 years, group II: 40-65 yeas, and group III: >65 years). Patient demographic & clinical characteristics were summarized by age group within each clinical stage using frequencies and relative frequencies. Associations were evaluated using the Chi-square test. Overall survival was summarized by age group within each clinical stage using the Kaplan–Meier method. Associations were evaluated using log-rank test. One- and 3-year survival rates with 95% confidence interval (CI) were calculated.
A total of 423,482 patients between 2004 and 2017 were included in the study after application of inclusion and exclusion criteria. Patient demographic and clinical characteristics were summarized by age group within each clinical stage, and the results are shown in Table I, Table II, Table III and Table IV. Among younger patients, this group tended to have higher proportions of Black or Hispanic patients, and uninsured individuals with lower income. Table V reports the 1-year, 3-year, and median survival rate for each age group within each clinical stage. Patients aged between 18 and 40 had the worst 3-year survival rate among stage 1 disease. However, patients aged over 65 had the worst 3-year survival rate within the more advanced clinical stages 3 and 4.
Age is an established factor for cancer prognosis (11-14). In this study examining pancreatic cancer, the youngest age group with early-stage disease displayed the 3-year survival rate. This finding was significant as many studies generally state that younger age leads to higher rates of survival. However, many of these studies did not account for clinical stage at which these patients were diagnosed. Furthermore, the oldest age group over 65 years had the worst prognosis for advanced clinical stage 3 and 4. This is consistent with a study performed in the UK that found younger patients aged between 20 and 40 had the best survival rate when diagnosed with a lower pathological grade and at an earlier stage. Furthermore, they also found that patients older than 80 years had the worst survival rate (15-17). Another study observed that patients older than 70 had lower survival rate than their younger counterparts (18).
Regarding younger age groups, early onset pancreatic cancer generally is associated with more aggressive disease but not necessarily a worse outcome (18). Conversely, older patients’ overall survival may be influenced by comorbid conditions and more years of tobacco use. Clinical stage can alter approach to treatment, as operability and fitness for chemotherapy may vary accordingly. Surgical, medical, and radiation oncologists could also be more reluctant to pursue aggressive treatment in the elderly, whereas work harder to treat younger patients as stated by a study that analyzed the SEER Medicare database (18, 19).
Pancreatic cancer incidence continues to rise in the developing world. Age is an important indicator of prognosis. There remains a gap in how risk factors, socioeconomic backgrounds, and treatment modalities stratified by age affect prognosis. In our study, younger patients tended to be black or Hispanic, have lower income and have no insurance. Further study is needed to determine whether these differences are associated with poorer outcomes among patients with early-onset disease.
The Authors declare no conflicts of interest in relation to this study.
Project conception and design: AAK, KA, EG; Data collection: AAK, MAA; Data analysis: KA, EG; Editing: MB, SN, EG; Final approval: All Authors.
The American College of Surgeons Committee on Cancer provided the Participant User File from the National Cancer Database, but has not reviewed or validated the results or conclusions of our study.