How Old is Too Old: Treatment and Survival Disparities in Resectable Pancreatic Head Cancer: An Analysis Using the National Cancer Database

Document Type

Conference Proceeding

Publication Date

9-2019

Publication Title

J Am Coll Surg

Abstract

Introduction: Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) has acceptable morbidity and mortality in elderly patients. However, the definition of advanced age has varied in the literature. We sought to describe outcomes and treatment disparities among age deciles in those with stage I to II PDAC. Methods: The National Cancer Database was queried for patients with PDAC from 2010 to 2015. Patients with stage I to II disease were stratified by deciles (50 to 59 years, 60 to 69 years, 70 to 79 years, and 80 to 89 years), then grouped by treatment; no treatment (NT), systemic therapy only (ST), resection only (R), neoadjuvant therapy+resection (NAT+R), resection+adjuvant therapy (R+AT), and NAT+R+AT. The frequencies of each treatment type were stratified by age decile. Overall survival was estimated from time of diagnosis using Kaplan-Meier curves and compared using log-rank tests. All statistical analyses were performed in R, version 3.5.2. Results: A total of 26,927 patients were identified. Older patients were more likely to receive NT (50 to 59 years: 8.1%, 60 to 69 years: 10.5%, 70 to 79 years: 15.5%, 80 to 89 years: 32.4%; p < 0.001), less likely to receive a NAT approach (NAT+R+/-AT: 50 to 59 years: 14.6%, 60 to 69 years: 12.1%, 70 to 79 years: 7.8%, 80 to 89 years: 1.9%; p < 0.001), and less likely to receive AT (R+AT: 50 to 59 years: 34.2%, 60 to 69 years: 32%, 70 to 79 years: 25.2%, 80 to 89 years: 8.8%; p < 0.001). Treatment with R only increased with age (50 to 59 years: 7.9%, 60 to 69 years: 10.3%, 70 to 79 years: 13.1%, 80 to 90 years: 11.6%) with decreasing median survival (50 to 59 years: 16.6 months, 60 to 69 years: 13.5 months, 70 to 79 years: 12.1 months, 80 to 89 years: 11.7 months). Systemic therapy only increased with age (50 to 59 years: 35.2%, 60 to 69 years: 3 5.1%, 70 to 79 years: 38.4%, 80 to 89 years: 45.4%) with decreasing median survival (50 to 59 years: 12.0 months, 60 to 69 years: 10.5 months, 70 to 79 years: 9.2 months, 80 to 89 years: 7.5 months). Median survival decreased across groups with increasing age (50 to 59 years: 17.9 months, 60 to 69 years: 15.7 months, 70 to 79 years: 12.3 months, 80 to 89 years: 7.3 months) (Figure). There was no significant survival difference between younger patients and octogenarians for patients receiving NAT+R. Conclusions: Resection with NAT and/or AT maximized survival in resectable PDAC. There appears to be underuse of systemic therapy with operation for older patients with early-stage PDAC. [Figure presented]

Volume

229

Issue

4

First Page

S263

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