Exploring the role of adjuvant chemotherapy in older patients with early-stage pancreatic adenocarcinoma.

INTRODUCTION: The survival advantage of adjuvant chemotherapy (AC) for older patients with stage I pancreatic ductal adenocarcinoma (PDAC) is unclear, yet it is a mainstay of treatment. This study aims to explore the association of AC with overall survival (OS) in patients of various age groups. MATERIALS AND METHODS: A total of 6052 patients with stage I PDAC treated with pancreatectomy were retrospectively analyzed using data from the National Cancer Database. Patients were categorized by age and by AC treatment. Kaplan-Meier curves analyzed OS within each age group and were compared using log-rank test. Multivariable analyses using Cox proportional hazard regression models compared OS between patients receiving versus not receiving AC and between patients receiving single-agent versus multi-agent AC. RESULTS: Upon multivariable analysis, patients aged 65-74 (n = 2243) and 75-84 (n = 1623) who received surgery and AC had significantly longer OS compared to surgery alone (HR 0.72, 95% CI 0.62-0.83 and HR 0.73, 95% CI 0.63-0.86, respectively). In patients <65 years (n = 1970) and 85 years or older (n = 221), receipt of AC was not associated with greater OS (0.91, 0.77-1.09 and 1.08, 0.69-1.69, respectively). Multi-agent chemotherapy was not associated with greater OS compared to single-agent. DISCUSSION: This was the first retrospective study to examine the relationship between AC and OS by age in patients with stage I PDAC. There was significant observed OS increase in patients 65-74 and 75-84 but not in patients <65 and ≥ 85. These findings highlight the necessity for further research into standard adjuvant therapies for patients with early stage PDAC by various age groups.