Treatment patterns and survival outcomes in patients with non-metastatic early-onset pancreatic cancer

doi:10.3748/wjg.v30.i12.1739

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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.

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
Processing time: 69 Days and 4.9 Hours

ARTICLE HIGHLIGHTS

Research background

The incidence of early-onset pancreatic cancer (EOPC) is showing an increasing trend worldwide. Pancreatic cancer (PC) is insensitive to monotherapy and has a poor prognosis.

Research motivation

There are few studies on EOPC. The role of combination therapies, including surgery, radiotherapy, and chemotherapy, in non-metastatic EOPC is unclear.

Research objectives

To explore the survival outcomes of combination therapy in patients with non-metastatic PC.

Research methods

A total of 277 patients with non-metastatic EOPC who received antitumor therapy in a tertiary care hospital were retrospectively collected. Survival curves were plotted using the Kaplan-Meier method. Univariate and multivariate analyses using Cox proportional hazards modeling were performed to determine prognostic factors.

Research results

With a median follow-up time of 34.6 months, the 1-year, 2-year, and 3-year overall survival (OS) rates for the 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) was 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 was 28.5 months, 25.6 months, and 14.0 months, respectively (P = 0.002). The median OS after regional recurrence was 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.

Research conclusions

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

Research perspectives

This study proposed that patients with EOPC should be treated with aggressive multimodal therapy. However, multicenter randomized controlled studies are needed to further understand this subject.