Study Explores Trends in Young-Onset Pancreatico-Biliary Adenocarcinoma

Young-onset disease presentation on the rise

Research led by Cleveland Clinic experts highlights an increasing number of young-onset pancreatico-biliary cancers. The data, which was recently presented during the ASCO 2022 Annual Meeting, found that young-onset pancreatico-biliary adenocarcinoma (PBA) was associated with better survival outcomes when compared with average-onset disease.

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“With a growing recognition of the increasing number of gastrointestinal cancers among younger individuals, there are efforts underway to better understand the reason behind this trend,” notes study author Alok Khorana, MD, of Cleveland Clinic. “While investigating this issue in colorectal cancer patients, we realized that there isn’t as much attention focused on other gastrointestinal malignancies such as gastric and pancreatico-biliary cancers, which are also typically considered diseases found in older populations.”

To fill this knowledge gap, Dr. Khorana and colleagues initiated the current study to evaluate trends and characteristics of young-onset pancreatico-biliary adenocarcinoma compared with average-onset disease.

Study details

The researchers included patients from the National Cancer Database who were diagnosed with PBA between 2004 and 2017. In this study, young-onset and average-onset disease were defined as a diagnosis at the age of 50 years or younger and older than 50 years, respectively.

Of the 360,764 patients analyzed, 20,822 (5.8%) had young-onset PBA with a median age at diagnosis of 45 years. Comparatively, the median age at diagnosis for average-onset disease was 70 years old. During the study period, the data showed that the number of patients with young-onset PBA increased by 33.3% versus 111.8% among average-onset disease.

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“In terms of risk factors, the researchers observed that male sex, Black race, lower income and lower education were all associated with young-onset PBA,” says study author and Cleveland Clinic Hematology/Oncology fellow Thejus Jayakrishnan, MD. “This is important because these factors have been identified in young-onset colorectal cancer as well, suggesting that there could be a connection between demographics and socioeconomic factors and the early onset of cancer, especially in gastrointestinal malignancies.”

The data showed that patients with young-onset PBA were more likely to present with stage-IV disease compared to average-onset PBA. The median overall survival for young-onset patients was 11 months versus 7.1 months for average-onset disease, the researchers reported.

While the impact patient characteristics had on overall survival differed significantly between the two groups, the study authors found that Black patients experienced worse outcomes among both young- and average-onset PBA.

“As we hypothesized, demographics, such as race, sex and socioeconomic status, do impact the incidence and outcomes for young-onset cancer,” notes Dr. Jayakrishnan. “More work needs to be done to address disparities that impact a patient’s risk of developing disease as well their ability to access appropriate care.”

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Significance and next steps

These findings shed light on key trends and characteristics of young-onset PBA, including a rising incidence, according to Dr. Khorana, who emphasized the need for further study.

“Our work confirms that we are now seeing increasing rates of disease among younger patients across different cancer types,” he says. “While significant progress has been made and cancer mortality is on the decline overall, it is important that we have a better understanding of why there is a growing number of patients presenting with young-onset disease.”

“In colorectal cancer, current evidence suggests that dietary and lifestyle factors may be playing a role and influencing the growing risk of young-onset disease by altering the gut microbiome or microorganisms that live in the gastrointestinal tract,” notes Dr. Khorana. “Given these findings, we need to investigate whether we are seeing similar microbiome changes among individuals developing pancreatico-biliary cancer.”

For Dr. Khorana and his colleagues, their next step is to conduct similar studies in the PBA patient population to explore this more carefully and gain a better understanding of why there is a growing risk for disease among younger individuals.