Octogenarians Undergoing Pancreaticoduodenectomy versus Definitive Radiotherapy for Locoregional Therapy of Pancreatic Ductal Adenocarcinoma: A Nationwide Analysis.

[BACKGROUND] Pancreaticoduodenectomy (PD) remains the standard for locoregional therapy of pancreatic ductal adenocarcinoma (PDAC) in the head of the pancreas. However, even with optimal treatment, the prognosis for pancreatic cancer is poor, and octogenarians have a reduced life expectancy, thus potentially offsetting benefits of aggressive surgical intervention. The aim of this study was to compare survival outcomes with PD versus radiotherapy alone (dXRT) in octogenarians with non-metastatic PDAC.

[METHODS] We queried a national database to identify patients aged ≥80 years diagnosed with resectable or borderline-resectable PDAC in the head of the pancreas between 2004 and 2019. We performed a propensity score match to compare PD and dXRT.

[RESULTS] A total of 7910 patients were included in the analysis. The mean age was 83.1 ± 2.6 years, and 44.8% were male (n=3546) and 85.9% white (n=6795). The median survival of the overall cohort was 11.53 (interquartile range [IQR] 5.88-21.78) months. Among the matched cohort of 2982 patients, those who underwent PD had better median overall survival (OS; 14.65 [IQR 6.93-30.75] vs. 9.66 [IQR 5.72-15.87] months, p<0.001). In patients with early-stage (stage I and II) disease, PD was associated with a higher 5-year OS (13.03% vs. 2.07%, p<0.001). However, among patients with advanced-stage (stage III) disease, there was no difference in 5-year OS (4.67% vs. 2.02%, p=0.151).

[CONCLUSIONS] Octogenarians with non-metastatic PDAC have a poor long-term prognosis. Although PD is associated with a modest survival benefit in patients with early-stage disease, there is no associated survival benefit when compared with dXRT in patients with advanced-stage disease.