Young Adults With Pancreatic Cancer: National Trends in Treatment and Outcomes.
Adolescent
Adult
Age Factors
Databases, Factual
Female
Healthcare Disparities
/ ethnology
Humans
Incidence
Male
Middle Aged
Minority Health
/ trends
Outcome Assessment, Health Care
/ trends
Pancreatic Neoplasms
/ diagnosis
Practice Patterns, Physicians'
/ trends
Race Factors
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
/ epidemiology
Young Adult
Journal
Pancreas
ISSN: 1536-4828
Titre abrégé: Pancreas
Pays: United States
ID NLM: 8608542
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
pubmed:
7
3
2020
medline:
26
2
2021
entrez:
6
3
2020
Statut:
ppublish
Résumé
The treatment and outcomes of patients younger than 50 years (young adults [YAs]) with pancreatic cancer are largely unknown. We evaluated the presentation, treatment, and outcomes of these patients. The National Cancer Database was analyzed. Univariate and multivariate Cox proportional hazards models were performed to identify variables associated with overall survival. A total of 124,442 patients with pancreatic cancer were identified, with 9657 between 18 and 50 years of age. Mean age was 45.4 years (standard deviation, 4.6 years). About 30.9% of YA patients and 25% of patients older than 50 years underwent resection of the primary tumor. Survival advantage was seen for patients 18 to 39 years (hazard ratio, 1.14; 95% confidence interval, 1.07-1.23; P < 0.001). This age advantage was similar across all the racial groups. Overall, YAs treated between 2009 and 2013 had higher survival rates compared with 2004 to 2008 (hazard ratio, 0.85; 95% confidence interval, 0.81-0.89; P < 0.001). This survival improvement was highest in American Indians and Asian/Pacific Islanders (16.6% vs 6.5%), African Americans (10.6% vs 8.5%), and Hispanics (14.5% vs 12.6%). Survival of YAs with pancreatic cancer patients is superior to older patients and has improved over time, especially in minority populations.
Identifiants
pubmed: 32132513
doi: 10.1097/MPA.0000000000001502
pii: 00006676-202003000-00005
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
341-354Subventions
Organisme : NCI NIH HHS
ID : P30 CA138292
Pays : United States
Références
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.
Riall TS, Townsend CM Jr., Kuo YF, et al. Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancer: a 2-step process. Cancer. 2010;116:930–939.
Nipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7:525–535.
Bleyer A, Barr R, Hayes-Lattin B, et al. The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer. 2008;8:288–298.
Fidler MM, Gupta S, Soerjomataram I, et al. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. Lancet Oncol. 2017;18:1579–1589.
Jung EJ, Lee HJ, Kwak C, et al. Young age is independent prognostic factor for cancer-specific survival of low-stage clear cell renal cell carcinoma. Urology. 2009;73:137–141.
Dini G, Banov L, Dini S, et al. Where should adolescents with ALL be treated? Bone Marrow Transplant. 2008;42(suppl 2):S35–S39.
Sender L, Zabokrtsky KB. Adolescent and young adult patients with cancer: a milieu of unique features. Nat Rev Clin Oncol. 2015;12:465–480.
Ohmoto A, Yachida S, Kubo E, et al. Clinicopathologic features and germline sequence variants in young patients (≤40 years old) with pancreatic ductal adenocarcinoma. Pancreas. 2016;45:1056–1061.
Raissouni S, Rais G, Mrabti H, et al. Pancreatic adenocarcinoma in young adults in a moroccan population. J Gastrointest Cancer. 2012;43:607–611.
Wray CJ, Castro-Echeverry E, Silberfein EJ, et al. A multi-institutional study of pancreatic cancer in Harris County, Texas: race predicts treatment and survival. Ann Surg Oncol. 2012;19:2776–2781.
Singal V, Singal AK, Kuo YF. Racial disparities in treatment for pancreatic cancer and impact on survival: a population-based analysis. J Cancer Res Clin Oncol. 2012;138:715–722.
Khawja SN, Mohammed S, Silberfein EJ, et al. Pancreatic cancer disparities in African Americans. Pancreas. 2015;44:522–527.
Scarton L, Yoon S, Oh S, et al. Pancreatic cancer related health disparities: a commentary. Cancers (Basel). 2018;10:pii: E235.
Atkins JJ, Fiala MA, Wang-Gillam A, et al. Racial disparities in the outcomes of patients with stage IV pancreatic adenocarcinoma are mediated by chemotherapy utilization. Pancreas. 2016;45:e33–e34.
Vick AD, Hery DN, Markowiak SF, et al. Closing the disparity in pancreatic cancer outcomes: a closer look at nonmodifiable factors and their potential use in treatment. Pancreas. 2019;48:242–249.
Liu Y, Nickleach DC, Zhang C, et al. Carrying out streamlined routine data analyses with reports for observational studies: introduction to a series of generic SAS ® macros. F1000Res. 2018;7:1955.
Salami A, Obaid T, Joshi ART. Trends in the clinical presentation, treatment, and survival for pancreatic adenocarcinoma. Am J Surg. 2019;217:103–107.
Kuroda T, Kumagi T, Yokota T, et al. Improvement of long-term outcomes in pancreatic cancer and its associated factors within the gemcitabine era: a collaborative retrospective multicenter clinical review of 1,082 patients. BMC Gastroenterol. 2013;13:134.
Wang-Gillam A, Li CP, Bodoky G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet. 2016;387:545–557.
Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–1703.
Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010;304:1073–1081.
Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–277.
Improved survival seen for some with pancreatic cancer. Cancer Discov. 2018;8:OF1.
Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379:2395–2406.
Shaib WL, Ip A, Cardona K, et al. Contemporary management of borderline resectable and locally advanced unresectable pancreatic cancer. Oncologist. 2016;21:178–187.
Artinyan A, Soriano PA, Prendergast C, et al. The anatomic location of pancreatic cancer is a prognostic factor for survival. HPB (Oxford). 2008;10:371–376.
Mukhija D, Sohal DPS, Khorana AA. Adjuvant treatment in potentially curable pancreatic cancer: need to include tumor location in the equation? Pancreas. 2018;47:e50–e52.
Sierzega M, Popiela T, Kulig J, et al. The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer. Pancreas. 2006;33:240–245.
Hattangadi JA, Hong TS, Yeap BY, et al. Results and patterns of failure in patients treated with adjuvant combined chemoradiation therapy for resected pancreatic adenocarcinoma. Cancer. 2009;115:3640–3650.
Reni M, Zanon S, Balzano G, et al. Selecting patients for resection after primary chemotherapy for non-metastatic pancreatic adenocarcinoma. Ann Oncol. 2017;28:2786–2792.
Adler NE, Ostrove JM. Socioeconomic status and health: what we know and what we don't. Ann N Y Acad Sci. 1999;896:3–15.
Alexander D, Jhala N, Chatla C, et al. High-grade tumor differentiation is an indicator of poor prognosis in African Americans with colonic adenocarcinomas. Cancer. 2005;103:2163–2170.
Cooper GS, Yuan Z, Landefeld CS, et al. Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health. 1996;86:582–586.
Cooper GS, Koroukian SM. Geographic variation among Medicare beneficiaries in the use of colorectal carcinoma screening procedures. Am J Gastroenterol. 2004;99:1544–1550.
Cooper GS, Koroukian SM. Racial disparities in the use of and indications for colorectal procedures in Medicare beneficiaries. Cancer. 2004;100:418–424.
Rebbeck TR. Prostate cancer genetics: variation by race, ethnicity, and geography. Semin Radiat Oncol. 2017;27:3–10.
Olopade OI, Fackenthal JD, Dunston G, et al. Breast cancer genetics in African Americans. Cancer. 2003;97(suppl 1):236–245.
Bollig-Fischer A, Chen W, Gadgeel SM, et al. Racial diversity of actionable mutations in non-small cell lung cancer. J Thorac Oncol. 2015;10:250–255.