Early-onset Pancreatic Cancer is Associated With Better Survival: A SEER Population-Based Analysis

The incidence of early-onset pancreatic cancer is increasing worldwide. This study aimed to evaluate whether survival differences between early and late-onset pancreatic cancer persist after adjustment for tumor characteristics, stage at diagnosis, and treatment, including within stage and treatment-specific subgroups.

This retrospective SEER cohort study included patients with pancreatic adenocarcinoma diagnosed between 2004 and 2020, with survival follow-up through 2022. Multivariable Cox regression analyses were performed to evaluate overall survival (OS) and cancer-specific survival (CSS) according to age group.

Among 131,839 patients, 6,366 (4.8%) had early-onset pancreatic cancer and 125,473 (95.2%) had late-onset pancreatic cancer. The median OS was 9 months for EOPC and 6 months for LOPC, while the median CSS was 10 months for EOPC and 6 months for LOPC. Adjusted OS and CSS remained worse in patients with LOPC, with consistent findings across all stages. Among patients who underwent surgery or received chemotherapy, LOPC was associated with poorer outcomes. There was no survival difference in patients with early-onset and late-onset pancreatic cancer among those who received radiation therapy.

This study demonstrated better overall survival and cancer-specific survival among EOPC after adjustment for clinical covariates including stage at diagnosis and treatment receipt, and histologic variables. The findings suggest that other factors beyond the available variables may contribute to better survival observed in younger patients. However, because information on chemotherapy regimens, treatment completion, and performance status was unavailable in the SEER database, residual confounding affecting survival outcomes cannot be excluded, and the findings should therefore be interpreted with caution.