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Early Onset Pancreatic Cancer Clinical Characteristics and Survival Associations by use of the National Cancer Data Base

Dewey, Betsy (2017)
Master's Thesis
Committee Chair / Thesis Adviser: Gillespie, Theresa Wicklin
Committee Members: Bednarczyk, Robert A
Research Fields: Oncology; Epidemiology; Public health
Partnering Agencies: Hospital or other health care provider
Keywords: pancreatic cancer; early onset; National Cancer Database
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url: http://pid.emory.edu/ark:/25593/s1dmk

Abstract

Abstract

Early Onset Pancreatic Cancer: Clinical Characteristics and Survival Associations by use of the National Cancer Data Base

By Betsy Dewey

Background: A scarcity of data exists in younger patient populations with pancreatic ductal adenocarcinoma (PDAC) regarding their overall survival and patient characteristics as compared to typically aged patients with PDAC. This report compares a large cohort of patients with PDAC <=50 years of age compared to patients diagnosed after 50 from the National Cancer Data Base (NCDB) over a 10-year period.

Methods: A retrospective analysis of Continuum of Care (CoC) accredited facilities who report their data to the NCDB identified PDAC cases <=50 years on the date of diagnosis and compared the tumor characteristics and survival associations to PDAC cases diagnosed at >50 years of age, between the years of 2004 through 2014, was performed. Covariates reviewed included demographics, clinical and pathological staging, receipt of surgery, and death or last date of follow-up. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.

Results: A total of 166,728 PDAC cases were identified for analysis. 13,103 (12.72%) cases were determined early onset pancreatic cancer due to diagnoses before or at the age of 50 years and 153,625 (87.28%) cases diagnosed after the age of 50 years. Age range: 18-90. Men in the sample accounted for 7,615 (58.12%) and 77,686 (50.57%) for early onset and typical onset cases, respectively. Women represented 5,488 (41.88%) and 75,939 (49.43%) for early onset and typical onset cases, respectively. Early onset cases were more frequently diagnosed with late stage PDAC and metastatic disease; however, overall survival was better for the younger patient population compared to the older patient population. For every one-year increase in age, the hazard of death increased by 9.7%. African-Americans, both early onset and typical onset, had worse survival compared whites in both age subgroups.

Conclusions: This is the first study using the NCDB to compare clinical characteristics and survival associations among early onset pancreatic cancer patients. The data suggests that despite being diagnosed with similar advanced stage disease, EOPC patients appear to have better overall survival compared to TOPC, which may reflect other causes of death among older patients. The data also provide evidence that highlights the racial disparity among survival of African-Americans compared to whites.


Table of Contents

Table of Contents

Introduction and Rationale

Problem Statement

Research Question/Hypothesis

Background

Early Onset versus Typical Age of Onset Pancreatic Patients

Methods

National Cancer Database

Study Population

Statistical Analysis

Results

Demographics

Table 1. Characteristics of Pancreatic Ductal Adenocarcinoma by Age of Onset Subgroups, 2004-2014

Hazard Ratio by Age of Onset

Survival by Clinical Stage and Age Subgroups

Survival by Race and Age Subgroups

Survival by Primary Site and Age Subgroups

Survival by Resected Patients and Age Subgroups

Discussion

Conclusion

References

Table 2. Hazard Ratio by Age Subgroups

Figure 1. Overall Survival Among Age Subgroups: Early Onset versus Typical Onset

Figure 2. Stage 2 Survivals by EOPC versus Typical Onset

Figure 3. Stage 3 Survivals by EOPC versus Typical Onset

Figure 4. Survival Curves for Whites by Age Subgroups

Figure 5. Survival Curves for African-Americans by Age Subgroups

Figure 6. Survival Curves for Race by Age Subgroups

Figure 7. Survival for Head of Pancreas Tumor by Age Subgroups:

Figure 8. Resected Patient Survival by Age Subgroups

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Access restricted until 2019-06-12

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