title: Young patients undergoing resection of pancreatic cancer fare better than their older counterparts.
abstract: BACKGROUND
  The median age of pancreatic ductal adenocarcinoma (PDAC) patients is 71 years. PDAC rarely affects individuals under the age of 45. We investigated features of PDAC occurring in young patients (≤45 years) who underwent surgical resection in order to determine if any difference exists in comparison to elderly patients (≥70 years).
  
  
  METHODS
  A retrospective analysis of patients with PDAC who were ≤ 45 years on the date of surgery between 1975 and 2009 was performed. This cohort was compared with PDAC patients whose ages were over 70 years on the date of surgery over the same time interval. Information reviewed included demographics, Charlson Age-Comorbidity Index (CACI), pathological staging, surgical management, and death or last follow-up.
  
  
  RESULTS
  Seventy five patients with PDAC of age ≤ 45 years at surgery were identified. The reference group consisted of 870 patients with a median age of 75. The most common symptoms of young patients were jaundice (45 %), abdominal pain (32 %), or weight loss (33 %). This did not differ significantly from older patients. Among the younger patients, 7 (9 %) underwent total pancreatectomy, 60 (80 %) underwent pancreaticoduodenectomy, and 8 (11 %) had distal pancreatectomy. The distribution of type of surgery was similar between two groups. Fifty-two of the young patients (69 %) had an R0 resection and this did not differ from the older age group (n = 616; 71 %). The rate of lymph node positivity was 68 % for younger patients and 74 % for older patients (p = 0.27). Of the younger patients, 11, 13, 49, and 2 were classified as stage I, IIA, IIB, and III, respectively, and did not differ from the older age group. The median overall survival for the young patients cohort was 19 months (95 % CI 15-22 months) which is longer than 16 months (95 % CI 14-17 months) of the older group (p = 0.007). The actual 5- and 10- year survival in young age group (24 and 17 %) was longer than that in old age group (11 and 3 %) (p < 0.05). The median CACI of the younger patients was 0.5 and was lower than 4.1 of the older patients (p < 0.0001).
  
  
  CONCLUSIONS
  The demographic, pathologic, and treatment characteristics of PDAC patients younger than 45 years were similar to those older than 70 years. Younger patients had fewer complications after curative resections. The better survival among younger patients is likely related to fewer comorbidities in this group. These findings will be useful in counseling young patients with resectable pancreatic cancer.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Osler 624, Baltimore, MD 21287, USA.
authors.forename: Jin
authors.initials: J
authors.lastname: He
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Lei
authors.initials: L
authors.lastname: Zheng
authors.forename: Christine
authors.initials: C
authors.lastname: Iacobuzio-Donahue
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate