Comparison of characteristics and outcomes of young‐onset versus average onset pancreatico‐biliary adenocarcinoma

BACKGROUND: Young‐onset gastrointestinal malignancies appear to be increasing in incidence. There are limited data on young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). METHODS: The study comprised patients with PBA (pancreatic adenocarcinoma, intra‐, and extra‐hepatic cholangiocarcinoma) and included in the National Cancer Database (NCDB) between 2004 and 2017. YO‐PBA was defined as a diagnosis at age less than 50 years. Logistic regression to assess factors associated with YO‐PBA status, and cox proportional hazards modeling to associate relevant factors with overall survival was performed. RESULTS: The study cohort comprised 360,764 patients, with 20,822 (5.8%) YO‐PBA. YO‐PBA was associated with (p‐values<0.0001 for all): male sex (6.3% YO‐male out of all male patients vs. 5.2% YO‐female, OR 1.29, 95% CI 1.25–1.33), Black race (7.9% YO‐Black vs. 5.0% YO‐White, OR 1.72, 95% CI 1.64–1.80), lower income (6.4% YO‐lowest household income based group vs. 5.5% highest, OR 1.08, 95% CI 1.03–1.13). YO‐PBA were more likely to present with stage‐IV disease (6.4% YO‐Stage IV of all stage IV vs. 5.4% YO‐Stage I–III, OR 1.25, 95% CI 1.21–1.29 p‐value < 0.0001). Factors associated with overall survival (OS) in non‐operable patients included—sex ‐ male vs. female, HR 1.12 (95% CI 1.08–1.15); race ‐ Black vs. White, HR 1.23 (95% CI 1.06–1.42); income group ‐ lowest vs. highest, HR 1.33 (95% CI 1.27–1.39), and treatment center type ‐ academic vs. nonacademic center, HR 0.87 (95% CI 0.85–0.90). CONCLUSIONS: Socioeconomic factors significantly impact incidence and outcomes for young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). More work is needed to help understand the mechanisms involved while addressing the disparities.