Treatment Sequencing and Survival in Octogenarians With Pancreatic Ductal Adenocarcinoma: A SEER Analysis

Pancreatic ductal adenocarcinoma (PDAC) in patients aged 80 years and older poses a significant therapeutic dilemma, as evidence supporting aggressive multimodality treatment in this population is limited. Using the Surveillance, Epidemiology, and End Results database, we evaluated overall survival in patients aged ≥80 years with localized or regional PDAC treated with surgery alone versus neoadjuvant chemoradiation followed by surgery. Kaplan-Meier analysis, multivariable Cox regression, and inverse probability of treatment weighting were used to adjust for demographic and disease-related factors. Among 3,806 eligible patients, surgery alone and neoadjuvant therapy plus surgery yielded identical median survival of 2.0 years in both localized and regional disease. No statistically significant survival advantage was observed with neoadjuvant therapy in adjusted analyses. These findings suggest that, in carefully selected octogenarians, upfront surgical resection provides survival outcomes comparable to more intensive neoadjuvant strategies, supporting individualized treatment approaches in this growing patient population.