Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Osler 624, Baltimore, MD 21287, USA.
J Gastrointest Surg. 2013 Feb;17(2):339-44. doi: 10.1007/s11605-012-2066-4. Epub 2012 Nov 27.
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).
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.
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).
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.
胰腺导管腺癌（PDAC）患者的中位年龄为 71 岁。PDAC 很少影响 45 岁以下的个体。我们研究了在接受手术切除的年轻患者（≤45 岁）中发生的 PDAC 的特征，以确定与老年患者（≥70 岁）相比是否存在任何差异。
对 1975 年至 2009 年间手术时年龄≤45 岁的 PDAC 患者进行回顾性分析。该队列与同期手术时年龄超过 70 岁的 PDAC 患者进行比较。回顾的信息包括人口统计学、Charlson 年龄合并症指数（CACI）、病理分期、手术管理以及死亡或最后一次随访。
确定了 75 名手术时年龄≤45 岁的 PDAC 患者。参考组由 870 名中位年龄为 75 岁的患者组成。年轻患者最常见的症状是黄疸（45%）、腹痛（32%）或体重减轻（33%）。这与老年患者没有明显区别。在年轻患者中，7 名（9%）接受了全胰切除术，60 名（80%）接受了胰十二指肠切除术，8 名（11%）接受了胰体尾切除术。两组手术类型的分布相似。52 名年轻患者（69%）行 R0 切除术，与老年组（n=616；71%）无差异。年轻患者的淋巴结阳性率为 68%，老年患者为 74%（p=0.27）。年轻患者中，11、13、49 和 2 名分别被归类为 I 期、IIA 期、IIB 期和 III 期，与老年组无差异。年轻患者队列的中位总生存期为 19 个月（95%CI 15-22 个月），长于老年组的 16 个月（95%CI 14-17 个月）（p=0.007）。年轻组的实际 5 年和 10 年生存率（24%和 17%）长于老年组（11%和 3%）（p<0.05）。年轻患者的 CACI 中位数为 0.5，低于老年患者的 4.1（p<0.0001）。
年龄小于 45 岁的 PDAC 患者的人口统计学、病理学和治疗特征与年龄大于 70 岁的患者相似。年轻患者在接受根治性手术后并发症较少。年轻患者的生存状况较好可能与该组患者合并症较少有关。这些发现将有助于为可切除胰腺癌的年轻患者提供咨询。
