Early onset PDAC – an analysis of patients under 50 years of age within the German cancer registry

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease with a 5-year overall survival of less than 13% and is predicted to be the second leading cause of cancer death by 2030. PDAC is a disease of the average population group with median age about 70 years old. But there is an increasing incidence of younger patients. In this study, we aimed to characterize the pancreatic cancer population younger than 50 years.

Methods: Retrospective data was obtained from pooled data of 18 clinical cancer registries in Germany. Patients with ICD-10-code C25.0-3, and C25.7-9, and histo code: 8140 und 8500 (WHO classification) were included. Data was dichotomized into patients under and equal 50 years and older than 50 years. Overall and disease-free survival (OS/DFS) were analyzed using Kaplan-Meier analyses. Subgroups by histologic type, type of surgery and years of first diagnosis were analyzed. Cox regression for OS were performed.

Results: 4.5% (3.639/81.538) of PDAC patients were younger than 50 years at the time of diagnosis. When we analyzed PDAC diagnoses between this periods, the number of PDAC diagnoses rose from 14.110 to 42.055 patients, but percentage of young patients decreased over time. Young patients had higher tumor stage (for example cT4: 42,2% vs. 37,71%, p<0.001), and were subjected to any type of treatment more often (70% (n=2575) vs 60% (n=46606), p<0.001). Furthermore we showed that metastastic behavior in younger patients differ from elder patients (p<0,001). Median OS, but not DFS was significantly better in young patients (12 months vs. 8 months, p<0.001 and 9.6 vs. 9.1 months, p=0.099). When treated with surgery with or without neoadjuvant chemotherapy, OS was also significantly longer in young patients (Median 19 (18-20) vs 16 (15-16) months, p<0.001). COX regression analysis for the younger patient revealed the R-status and the pN-status as only independently associated variables with overall survival (RR 2,04 and 1,8). For the elder patients, age, ECOG (RR 1,2), pN-status (RR 1,3), R-status (RR 1,26) and grading G (RR 1,29) were significantly associated with survival.

Discussion: For young patients fewer tumor characteristics seem to be associated with overall survival than in older patients. This might imply age as a very strong predictor of survival in this patient group and could suggest that an aggressive treatment approach in the young PDAC patients leads to better overall survival.

 

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Publication History

Article published online:
04 September 2025