Impact of age on treatment approach and survival in patients with malignant intraductal papillary mucinous neoplasms (IPMNs)


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Apostolos Gaitanidis1,Michail Alevizakos2,Alexandra Tsaroucha1,Michail Pitiakoudis1
1Democritus University of Thrace Medical School,2University of Pittsburgh Medical Center

Abstract

Background

Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumors. The purpose of this study is to identify how patients’ ages may contribute to selection between different treatment approaches as well as subsequent survival outcomes for patients with malignant IPMNs.

Method

A retrospective search of the Surveillance Epidemiology and End Results (SEER) database was performed. Survival analysis was performed using the log-rank test and Cox regression analysis in terms of both disease-specific survival (DSS) and overall survival (OS).

Results

Overall, 8711 patients were included (136 aged 9-39 y, 7248 aged 40-79 y and 1325 aged ≥80 y). Younger patients were more likely to undergo surgery (50% vs. 23.2% vs. 12.6% respectively, p<0.001), lymphadenectomy (20.6% vs. 15.6% vs. 9.4%, p<0.001) and radiation therapy (22.1% vs. 17.2% vs. 8.2%, p<0.001). Among patients aged ≥80 years, undergoing surgery was independently associated with improved DSS (HR 2.45; 95% CI: 1.68-3.58; p<0.001) and OS (HR 2.2; 95% CI: 1.57-3.06; p<0.001). A sub-analysis of patients with distant metastatic disease showed that undergoing cancer-directed surgery was the only factor associated with improved survival on univariate analysis in patients aged <40 y (DSS: 7 mo vs. 5 mo, p=0.066, OS: 7 mo vs. 4 mo, p=0.047) and an independent prognostic factor for  patients aged 40-79 y (DSS: 4 mo vs. 6 mo; HR 1.94; 95% CI: 1.35-2.77; p<0.001, OS: 3 mo vs. 5 mo; HR 1.63; 95% CI: 1.21-2.20; p=0.001), but not for patients ≥80 y, where radiation therapy was instead associated with improved survival (DSS: 5 mo vs. 2 mo; HR 1.98, 95% CI: 1.26-3.11; p=0.003, OS: 4 mo vs. 1 mo; HR 1.68; 95% CI: 1.19-2.38; p=0.003).

Conclusion

As age decreases, patients are subjected to more aggressive treatment. Younger patients with distant metastatic disease may benefit from cancer-directed surgery, while older patients benefit from radiation therapy.