Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2024; 30(12): 1739-1750
Published online Mar 28, 2024. doi: 10.3748/wjg.v30.i12.1739
Treatment patterns and survival outcomes in patients with non-metastatic early-onset pancreatic cancer
Le-Tian Zhang, Ying Zhang, Bi-Yang Cao, Chen-Chen Wu, Jing Wang
Le-Tian Zhang, Bi-Yang Cao, Chen-Chen Wu, Graduate School, Chinese PLA Medical School, Beijing 100853, China
Le-Tian Zhang, Jing Wang, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Ying Zhang, Department of Internal Medicine, Hospital of University of Science and Technology Beijing, Beijing 100083, China
Bi-Yang Cao, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Co-first authors: Le-Tian Zhang and Ying Zhang.
Author contributions: Wang J was involved in the study conception, design and supervision; Zhang LT and Zhang Y contributed equally to this work in design of the research, collection and analysis of the data, and writing of the first draft of the manuscript; Cao BY and Wu CC contributed to conceiving the research and analyzing the data. Zhang LT and Zhang Y contributed equally to this study, so they are the co-first authors of this paper.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of Chinese PLA General Hospital.
Informed consent statement: As the study used anonymous and pre-existing data, the informed consent from patients was waived.
Conflict-of-interest statement: All authors declare having no potential conflicts of interest related to this study.
Data sharing statement: The dataset is available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Wang, MD, Chief Doctor, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. wangjing@301hospital.com.cn
Received: January 19, 2024
Peer-review started: January 19, 2024
First decision: February 5, 2024
Revised: February 19, 2024
Accepted: March 6, 2024
Article in press: March 6, 2024
Published online: March 28, 2024
Abstract
BACKGROUND

The incidence of patients with early-onset pancreatic cancer (EOPC; age ≤ 50 years at diagnosis) is on the rise, placing a heavy burden on individuals, families, and society. The role of combination therapy including surgery, radiotherapy, and chemotherapy in non-metastatic EOPC is not well-defined.

AIM

To investigate the treatment patterns and survival outcomes in patients with non-metastatic EOPC.

METHODS

A total of 277 patients with non-metastatic EOPC who were treated at our institution between 2017 and 2021 were investigated retrospectively. Overall survival (OS), disease-free survival, and progression-free survival were estimated using the Kaplan–Meier method. Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors.

RESULTS

With a median follow-up time of 34.6 months, the 1-year, 2-year, and 3-year OS rates for the entire cohort were 84.3%, 51.5%, and 27.6%, respectively. The median OS of patients with localized disease who received surgery alone and adjuvant therapy (AT) were 21.2 months and 28.8 months, respectively (P = 0.007). The median OS of patients with locally advanced disease who received radiotherapy-based combination therapy (RCT), surgery after neoadjuvant therapy (NAT), and chemotherapy were 28.5 months, 25.6 months, and 14.0 months, respectively (P = 0.002). The median OS after regional recurrence were 16.0 months, 13.4 months, and 8.9 months in the RCT, chemotherapy, and supportive therapy groups, respectively (P = 0.035). Multivariate analysis demonstrated that carbohydrate antigen 19-9 level, pathological grade, T-stage, N-stage, and resection were independent prognostic factors for non-metastatic EOPC.

CONCLUSION

AT improves postoperative survival in localized patients. Surgery after NAT and RCT are the preferred therapeutic options for patients with locally advanced EOPC.

Keywords: Pancreatic cancer, Early-onset, Non-metastatic, Multimodal treatment, Radiotherapy, Overall survival

Core Tip: Young adults are an important subgroup of the pancreatic cancer (PC) patient population. This article describes the comprehensive treatment patterns and survival outcomes for patients with non-metastatic early-onset PC (EOPC) from a high-volume center. We demonstrated that adjuvant therapy significantly improves postoperative survival in patients with limited EOPC. We also found that radiotherapy-based combination therapy achieved favorable outcomes in patients with locally advanced and postoperative recurrence. Our findings support an aggressive multimodal treatment strategy for these unique patients.