Comparison of survival after chemotherapy vs no chemotherapy in elderly patients with pancreatic cancer.

Abstract

e16442 Background: Pancreatic cancer disproportionately affects older adults, yet real-world outcomes associated with chemotherapy in this population remain incompletely characterized. We evaluated clinical outcomes among patients aged ≥70 years with pancreatic cancer treated with chemotherapy compared with those who did not receive chemotherapy. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, comprising electronic health records from 170 healthcare organizations. Patients aged ≥70 years with a diagnosis of pancreatic cancer (ICD-10 C25) were included. The chemotherapy cohort included patients who received gemcitabine- or fluoropyrimidine-based regimens, including FOLFIRINOX or FOLFOX, after cancer diagnosis. Patients without documented chemotherapy exposure comprised the comparator cohort. Propensity score matching (1:1) was performed to balance demographics and comorbidities. Outcomes assessed from 30 days to 5 years after index event included all-cause mortality, hospitalization, emergency department visits, ICU admission, venous thromboembolism (VTE), infection, small bowel obstruction, and biliary tract obstruction. Kaplan–Meier survival and measures of association were used. Results: After matching, 3,612 patients in the chemotherapy cohort and 3,438 patients in the non-chemotherapy cohort were analyzed. Median survival in the chemotherapy cohort was 606 days, whereas median survival was not reached in the non-chemotherapy cohort; survival probability at the end of follow-up was 25.0% versus 64.0%, respectively. Chemotherapy was associated with significantly worse overall survival (hazard ratio [HR] 2.51, 95% CI 2.30–2.74; log-rank p < 0.001). Chemotherapy-treated patients experienced higher healthcare utilization and complication rates, including hospitalization (32.3% vs 9.4%; risk ratio [RR] 3.44), ED visits (10.8% vs 3.9%; RR 2.79), infections (17.4% vs 4.2%; RR 4.15), ICU admissions (9.1% vs 2.1%; RR 4.29), VTE (12.1% vs 2.3%; RR 5.16), SBO (4.5% vs 1.6%; RR 2.78), and biliary tract obstruction (7.7% vs 1.6%; RR 4.75), p < 0.001. Conclusions: In older adults with pancreatic cancer, chemotherapy was associated with significantly worse survival and substantially higher treatment-related morbidity and healthcare utilization. These findings highlight the need for careful patient selection and shared decision-making when considering chemotherapy in this vulnerable population.