Comparison of Early-, Average-, and Late-Onset Pancreatic Cancer in a Multi-Site Cancer Center: Treatment Patterns and Outcomes.

Purpose: The aim of this study was to investigate treatment and outcomes differences, as well as predictors of early mortality, among early-onset pancreatic adenocarcinoma (EOPC, ≤50 years), average-onset pancreatic adenocarcinoma (AOPC, 51-69 years), and late-onset pancreatic adenocarcinoma (LOPC, ≥70 years). Methods: We retrospectively analyzed 333 patients with pancreatic adenocarcinoma at a multi-site center between 2011-2018. Clinical, demographic, and treatment variables were compared by age group. Predictors of early mortality (death ≤6 months from diagnosis) were assessed using multivariable logistic regression. Survival outcomes were evaluated using Kaplan-Meier analyses. Results: Among the 333 patients, 56% were male, and the mean age was 61.5 years. EOPC patients had higher rates of tobacco use (68% vs 54%, p=0.0094) and higher histological grade (57% vs, 41%, p=0.048) than older cohorts. In non-metastatic patients, EOPC patients were more likely to undergo curative intent surgery (70% vs 38%, p≤0.0001) and receive adjuvant radiation (40% vs 15%, p=0.002). Early mortality occurred in 28% of non-metastatic and 59% of metastatic patients, with lower rates in EOPC. Predictors of early mortality included older age, higher neutrophil-to-lymphocyte ratio, lack of surgery, and absence of radiation therapy in univariable analysis; however, none of these factors remained significant in multivariable analysis. Median survival was 11.1 months in EOPC, 8.7 months in AOPC, and 4.3 months in LOPC. Conclusions: EOPC patients demonstrate better survival and receive more treatments than older cohorts. Despite these differences, PC outcomes remain poor across all groups. Further research is warranted to validate early mortality predictors and inflammatory biomarkers in EOPC.