Clinicopathologic differences in early- vs. late-onset pancreatic cancer: A retrospective cohort study.

Abstract

e16397 Background: Pancreatic cancer diagnosed in patients younger than 50 years has become increasingly common over the past two decades. In the United States, early-onset pancreatic cancer (EOPC) increased from approximately 1.1 to 1.4 per 100,000 between 2013 and 2022, with similar rising trends reported internationally, particularly in high-income countries compared to late-onset pancreatic cancer (LOPC). With this notable increase in incidence, characterizing EOPC is essential to improving diagnostic and therapeutic strategies. This study focuses on comparing clinicopathologic features of EOPC and LOPC to help identify distinguishing traits with potential clinical implications. Methods: This study was a single-center retrospective cohort study on patients with pancreatic cancer between 2002 and 2022 (n = 216). A study protocol was developed prior to analysis and approved by the institutional review board. Patients were classified as EOPC ( < 50 years, n = 37) or LOPC (≥50 years, n = 179). Variables analyzed included sex, race/ethnicity, body mass index (BMI), smoking and alcohol status, tumor location, stage at diagnosis, tumor grade, diabetes, family history of pancreatic cancer, and history of pancreatitis. Missing data were handled by complete-case analysis for each variable. Statistical analysis was performed using chi-square tests, Fisher’s exact tests (including Fisher–Freeman–Halton exact testing for race), and Welch’s t-test. Statistical significance was set at p < 0.05. Results: Patients with EOPC were more likely to be male compared with those with LOPC (73.0% vs 47.5%, p = 0.009 and also more frequently presented with advanced-stage disease (stage III–IV: 87.5% vs 69.6%, p = 0.041). Mean BMI was higher in EOPC than in LOPC (28.4 vs 26.5 kg/m²), and a history of pancreatitis was more common in EOPC (25.0% vs 11.2%); however, neither of these variables reached a statistically significant difference. No significant differences were observed between EOPC and LOPC in race distribution (White/Caucasian 73.0% vs 81.0%, Black/African American 18.9% vs 15.1%, Other 8.1% vs 3.9%), smoking (29.7% vs 22.3%), alcohol use (35.1% vs 41.3%), pancreatic head location (67.7% vs 66.5%), tumor grade (high grade 52.6% vs 54.1%), diabetes (41.7% vs 43.0%), or family history of pancreatic cancer (8.1% vs 5.0%) (all p > 0.05). Conclusions: Based on this study, EOPC was associated with males and more advanced stage at presentation. Other clinicopathologic features were largely similar between age groups, with non-significant trends toward higher BMI and greater prevalence of personal history of pancreatitis in EOPC. These findings suggest EOPC patients may represent a clinically different subgroup compared to LOPC and support the need for further studies to investigate the biological drivers of EOPC and refine risk-based screening and management for younger populations.