Prognostic analysis of very early onset pancreatic cancer: a population-based analysis

BACKGROUND: We aimed to use competing risk model to assess whether very early onset pancreatic cancer (VEOPC ) (<45 years) had a worse prognosis than older pancreatic cancer (PC) patients, and to build a competing risk nomogram for predicting the risk of death of VEOPC. METHODS: We selected pancreatic adenocarcinoma (PDAC) patients as our cohort from the Surveillance, Epidemiology, and End Results (SEER) database. The impact of cancer specific death was estimated by competing risk analysis. Multivariate Fine-Gray regression for proportional hazards modeling of the subdistribution hazard (SH) model based nomogram was constructed, which was internally validated by discrimination and calibration with 1,000 bootstraps. RESULTS: Our cohort included 1,386 VEOPC patients and 53,940 older patients. We observed that in unresectablePDAC patients, VEOPC had better cancer specific survival (CSS) than each older group (45–59 years, 60–69 years, 70–79 years and >79 years). There was no significant prognostic difference between VEOPC and each older group in resectablePDAC. Our competing nomogram showed well discrimination and calibration by internal validation. CONCLUSION: For unresectable PDAC patients, VEOPC had better CSS than older patients. Our competing risk nomogram might be an easy-to-use tool for the specific death prediction of VEOPC patients with PDAC.