Abstract
Background and AimsIn recent years, the best treatment method for pancreatic cancer in elderly patients has remained controversial. Surgery is the main treatment modality for pancreatic cancer. This study aimed to determine whether elderly patients with pancreatic cancer can gain survival advantages through more active and radical surgical treatment and evaluate the best treatment method and potential prognostic factors.MethodsFrom the Surveillance, Epidemiology, and End Results program (SEER) database, 10,557 elderly patients (aged ≥65 years) with pancreatic cancer were included as Cohort 1, and Propensity Score Matching (PSM) evaluation was performed to generate Cohort 2 (424 pairs). Overall Survival (OS) and Cause-Specific Survival (CSS) were determined using Kaplan–Meier survival curves, and differences were assessed using the Log-rank test. Multivariate logistic regression analysis and the forest plot of hazard ratio (HR) was made to assess the association between potential prognostic factors, including surgery and different surgical methods, and survival in elderly patients.ResultsWe identified 10,557 eligible patients with pancreatic cancer, who formed Cohort 1. The total OS and CSS in the surgery group were significantly higher than those in the non-surgery group (P < 0.001). Age, stage (AJCC 8th), grade, lymph node metastasis, radiation, chemotherapy, and surgical methods were independent factors affecting the prognosis of elderly patients. In Cohort 2, Total pancreatectomy (Total PT) had the lowest risk ratio (HR = 0.31, P < 0.001) and longest median CSS (18.000 months), while Extension Total pancreatectomy (Ex-Total PT, HR = 0.34, P < 0.001) showed the lower median CSS (17.000 months) and median OS (14.000 months). Partial pancreatectomy (Partial PT, HR = 0.46, P < 0.001) showed the lowest median CSS (13.000 months) and median OS (12.000 months), although they were still higher than the median CSS (6.000 months) and median OS (5.000 months) in the non-surgery group.ConclusionsBased on the SEER database, surgical treatment is an independent prognostic factor in elderly patients with pancreatic cancer. Compared with other surgical methods, Total PT can offer elderly patients the best survival advantages. However, Ex-Total PT, a more radical method, does not seem to be the best treatment option for the survival and benefit of elderly patients.
Highlights
Pancreatic cancer is a highly fatal condition [1]
Surgery plays an indispensable role in the treatment of pancreatic cancer, but it is unclear whether elderly patients can gain survival advantages from more active and radical surgical treatment
The results showed that the total OS and CSS in the surgery group were significantly higher than those in the non-surgery group (P < 0.001), indicating that the elderly patients with pancreatic cancer can gain significant survival advantages from surgery
Summary
Pancreatic cancer is a highly fatal condition [1]. The incidence of pancreatic cancer has been increasing year by year, and it is estimated that this pathology will become the second leading cause of cancer-related deaths by 2030 [2, 3]. Pancreatic cancer has “three highs and three lows,” that include high morbidity, high recurrence and metastasis, high mortality, low early diagnosis rate, low effective treatment efficiency, and low 5-year survival rate [6]. It is characterized by insidious onset and atypical early symptoms including abdominal discomfort, fullness, loss of appetite, and weight loss [7]. This study aimed to determine whether elderly patients with pancreatic cancer can gain survival advantages through more active and radical surgical treatment and evaluate the best treatment method and potential prognostic factors
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