Table 1.
Clinical studies dealing with early onset of PC
| ID | Year published (reference) | Investigated time period | Time range (years) | Study design | Age cutoff (years) | Number of EOPC cases [# all cases with PC (%)] | In comparison to LOPC | Median OS [months] n-years survival [%]) | Major conclusion | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Start | End | Risk factors | Treatment | EOPC | LOPC | |||||||
| 1 | 200285 | 1995 | 2000 | 5 | R | <50 | 175 [728 (24.0%)] | = | = | NM(bC) | Paradigm of environmental pollution and pancreatic cancer | |
| 2 | 200419 | NM | NM | NM | L | ≤40 | 10 [439 (2.3%)] | Hereditary factors | NM(bC) | NM(bC) | Clinicopathological findings were comparable to LOPC. EOPC patients frequently appeared to be associated with genetic factors | |
| 3 | 200923 | 1995 | 2008 | 12 | R | ≤45 | 136 [3,102 (4.4%)] | = | = | 12.3 | NM(bC) | Patients with stages I–II disease may have an improved prognosis; stages III–IV patients appear to be similar to the typical (older) patient population with PC |
| 4 | 201122 | 1993 | 2008 | 15 | R | <50 | 33 [576 (5.7%)] | NM | > Resection > Radiotherapy | 5.6 5-ys: 3.3% |
5.2 5 ys: 2.3% |
EOPC present at an advanced stage with frequent metastases and poor survival |
| 5 | 201186 | 1990 | 2009 | 25 | R | <50 | 25 [243 (10.8%)] | = | NM | 5.6 1-y: 28% 5-ys: 4% |
Pancreatic cancer easily is overlooked in young | |
| 6 | 201224 | 2005 | 2010 | 5 | R | ≤45 | 32 [176 (18.2%)] | = | NM(bC) | 6.8 | EOPC seem to have the same poor prognosis as the typical (older) patient. No special risk factors | |
| 7 | 20139 | 1975 | 2009 | 34 | R | ≤45 | 75 [945 (7.9%)] | = | NM(bC) | 19 5-ys: 24% 10-ys: 17% |
6 5 ys: 11% 10 ys: 3% |
The demographic, pathologic, and treatment characteristics of EOPC were similar to those older than70 years. The better survival among younger patients is likely related to less comorbidity in this group |
| 8 | 201587 | 2006 | 2013 | 7 | R | ≤50 | 25 [293 (8.5%)] | Tobacco | NM(bC) | 11 | 9 | EOPC seems related to active and early smoking, but not to familial syndromes. Young patients display aggressive disease but not worse outcome |
| 9 | 201688 | 1988 | 2013 | 15 | R | <50 | 118 [1,407 (8.4%)] | NM | = | 9.3 | 8.0 | Differences in clinical characteristics and associations with survival indicate that EOPC is distinct from LOPC |
| 10 | 201620 | 2002 | 2013 | 11 | R | ≤40 | 17 [908 (1.9%)] | Hereditary factors | =/(NMbC) | 6.7 1-y: 37.5% 3 ys: 25% |
Hereditary factors might have a weak, if any, relationship with EOPC | |
| 11 | 201689 | 1981 | 2016 | 35 | R | ≤40 | 526 [36,145 (1.5%)] | = | > Chemotherapy | 6.0 1 y: 28.2% 3 ys: 9.6% 5 ys: 7.8% |
7.0 1 y: 34.7% 3 ys: 12.0% 5 ys: 7.8% |
Younger patients with pancreatic adenocarcinoma were more often diagnosed at advanced stages, and the OS rate was worse than that in older patients |
| 12 | 20176 | 2000 | 2014 | 14 | R | ≤45 | 34 [699 (4.9%)] | NM | NM(bC) | 17 5 ys: 6.1% |
32 5 ys: 22.2% |
5a OS and recurrence patterns did not significantly differ between EOPC and LOPC. EOPC presents more features that are aggressive like Pn1 in EOPC. Higher systemic recurrence rate and a lower 5-year DFS rate in EOPC |
| 13 | 201721 | 1999 | 2014 | 15 | R | ≤45 | 156 [1,789 (8.7%)] | Tobacco Male | = | 8 1 y: 25.4% 2 ys: 8% |
NM(bC) | EOPC patients display aggressive disease and have a worse outcome; radical resection is the best treatment |
| 14 | 20187 | 2015 | 2017 | 2 | R | ≤45 | 24 [296 (8.1%)] | Alcohol Hereditary factors | = | NM(bC) | Alcohol consumption and family history of pancreatic neoplasia as significant risk factors for very EOPC | |
| 15 | 20185 | 2004 | 2015 | 11 | R | <50 | 35 [369 (9.5%)] | Demographics Male | More aggressive | 12 | 9 | Advanced disease, received more aggressive treatment, and had an overall similar survival outcome |
| Summary | Median/mean: 13/14.7a (range: 2–35a) | 1 L −14 R | ≤40 (3) ≤45 (6) <50 (6) | Median/mean: 34/94.7 [699/3,207.6 (8.1%/8.2%)] | Alcohol Demographics Hereditary Male Tobacco | EOPC patients receive a more aggressive therapy | Median: 8.6 Mean: 9.9 | Median: 8.0 Mean: 10.8 |
Risk factors: Tobacco, alcohol, male gender, pollution, demographics Clinical stage: is more advanced at the time of diagnosis Treatment: EOPC patients are more resilient for a more aggressive therapy Clinical outcome: improves with more aggressive therapy |
|||
Abbreviations: P, prospective; R, retrospective; L, literature; NM(bC), not mentioned (by comparison); OS, overall survival; Pn1, perineural invasion; ys, years survival, ≥ more, ≤ younger than; EOPC, early onset pancreatic cancer; PC, pancreatic cancer; LOPC, late-onset pancreatic cancer.