Pancreatic Adenocarcinoma in a Young Patient Population-12-Year Experience at Memorial Sloan Kettering Cancer Center
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.