Pancreatic adenocarcinoma in a young patient population - 12-Year experience at Memorial Sloan Kettering Cancer Center

Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Journal of Surgical Oncology (Impact Factor: 3.24). 07/2009; 100(1):8-12. DOI: 10.1002/jso.21292
Source: PubMed


There is a dearth of data in a younger population of patients with pancreatic ductal adenocarcinoma (PAC) regarding epidemiology, genetics, prognosis, and outcome. This report examines a large cohort of patients with PAC <or=45 years of age evaluated at MSKCC over a 12-year period.
A retrospective analysis of patients referred to MSKCC with PAC identified from the institutional tumor registry, who were <or=45 years on the date of the diagnostic biopsy, between January 1995 and February 2008, was performed. Information reviewed included demographics, clinical and pathological staging, surgical management, therapy, date of relapse, death or last follow-up. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.
One hundred thirty-six cases of PAC, age <or=45 years at diagnosis, were identified. Seventy-four (54%) females, 62 (46%) males. Age range: 24-45; 4, 38, and 94 patients in age groups 20-29, 30-39, 40-45 years, respectively. Fifty (37%) had a smoking history. Fourteen (10.3%) had a positive family history of PAC. Thirty-five (25.7%) underwent a curative resection for localized disease. Twenty-eight (20.1%) presented with locally advanced, inoperable disease. Sixty-eight (50%) presented as AJCC Stage IV. Twenty-three (37%) of those resected underwent adjuvant chemoradiation. Thirteen received adjuvant gemcitabine. The median overall survival for the entire cohort was 12.3 months (95% CI 10.2-14.0 months). The median overall survival for the patients with locally resectable disease was 41.8 months (95% CI 20.3-47 months). The median overall survival for the patients who presented with locally advanced, unresectable disease was 15.3 months (95% CI 12-19.3 months). The median overall survival for those who presented with metastatic disease was 7.2 months (95% CI 5.2-9.5 months).
This is the largest reported cohort of young patients with PAC <or=45 years of age. The data suggest that patients with stages I-II disease may have an improved prognosis, however the prognosis for stages III-IV patients appears to be similar to the typical (older) patient population with PAC.

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    • "These patients were diagnosed as EOPCs. The age cut-off value we implemented here (45 years) was selected based on the largest so far study of patients with EOPC performed by Dr. Duffy and associates at Memorial Sloan Kettering Cancer Center, New York [4]. Patients with neoplasms of non-ductal origin [e.g., acinar cell carcinomas, neuroendocrine neoplasms (NENs), solid pseudopapillary neoplasms] were carefully excluded from the main study group. "
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    ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) represents the fourth cause of death in cancer with a 5-year survival rate of less than 1-2%. Early onset pancreatic cancer (EOPC), i.e. patients below 50 years of age, is infrequently described. The present study aimed to determine the epidemiology, demographic incidence and prognosis of EOPC and to identify the characteristics that might distinguish EOPC. 576 consecutive patients with PDAC diagnosed from January 1993 to December 2008 at the University Hospital of Lund, Sweden. 65 different parameters were compared with a historic cohort of pancreatic cancer patients as well as with matched controls. 33 patients (5.7%) with PDAC were 50 years or younger. The overall survival was 170 days compared to 240 days for matched controls (p=n.s.). Patients with EOPC were diagnosed at a significantly more advanced stage, i.e. distant metastasis, (52%) as compared to matched controls (30%; p=0.04). EOPC-patients received more treatment than the compared PDAC-cohort. EOPC constituted 5.7 % of all PDAC, presenting at an advanced stage with frequent metastases and poor survival. The role of genetic alterations and the potential influence of environmental factors for EOPC are to be further investigated.
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