Predictors of early mortality in early and late onset pancreatic cancer (PC).
Authors: Kunal C. Kadakia, Sally J. Trufan, Laura W. Musselwhite, Zachary J. Wesson, Jimmy J. Hwang, Mohamed E. Salem
Journal: Journal of Clinical Oncology (2022)

543 Background: The incidence of early-onset PC (EOPC) is rising and is associated with substantial mortality. We sought to identify independent predictors of early mortality in a cohort of EOPC and matched older patients (pts). Methods: Pts with EOPC (≤50 years) and matched cohorts of average (51-69, AOPC) and late (≥70, LOPC) onset PC by sex, race, year of diagnosis, and presence of metastatic disease were identified using the institutional tumor registry for years 2011-2018. Demographic and clinicopathologic characteristics were retrieved. Overall time of survival was assessed using Kaplan-Meier curves and the Cox Proportional Hazards modeling. Multivariable regression was conducted to evaluate for predictors of early mortality in non-metastatic and metastatic pts, defined as either death within six months of diagnosis compared to those surviving at least 12 months. Results: In total, 100 pts with EOPC (median age 47, range 29-50), 100 pts with AOPC (median age 60, range 51-69), and 100 pts with LOPC (median age 78, range 70-93) were analyzed. Of these, 46% were female, 28% were black, and 43% had metastatic disease at presentation. In non-metastatic pts, the 12-mo. survival rate by age group was: EOPC 74.4% (95% CI 59-85), AOPC 60% (95% CI 43-73), and LOPC 32.4% (95% CI 18-47). Variables associated with mortality within 6 months of diagnosis in non-metastatic pts on univariable analysis included age group, BMI ≤25, ECOG performance status (PS), neutrophil-to-lymphocyte ratio ≥5 (NLR5), CA 19-9 ≥130, no surgical resection, and no adjuvant chemotherapy. Multivariable regression confirmed no surgical resection (Odds Ratio [OR] 9.6, 95% CI 3-29), no receipt of chemotherapy (OR 6.9, 95% CI 2-21), and NLR5 (OR 5.4, 95% CI 1-22) as independent predictors for early mortality in non-metastatic pts. In metastatic pts, the 12-mo. survival rate by age group was: EOPC 32.6% (95% CI 19-47), AOPC 27% (95% CI 15-41), and LOPC 5.8% (95% CI 1-16). On univariable analysis, variables associated with mortality within 6 months of diagnosis included age group, ECOG PS, and NLR5. Multivariable regression confirmed LOPC (OR 11.6, 95% CI 2-61) and NLR5 (OR 11, 95% CI 2-54) as independent variables for early mortality. Race, sex, BMI, CA 19-9, smoking, alcohol use, primary tumor location, and site of metastases were not associated with early mortality in metastatic pts. No difference in independent predictors of early mortality between EOPC and older pts were identified. Conclusions: In this cohort of EOPC and matched older pts, LOPC (age ≥70) and NLR5 were independently associated with early mortality by 6 months in metastatic pts. In non-metastatic pts, lack of curative intent surgery, no receipt of chemotherapy, and NLR5 were independently associated with early mortality. There were no independent predictors for early mortality that distinguished EOPC and older pts. Further work is needed to identify prognostic factors unique to EOPC.