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Outcomes in patients ≥ 80 years with a diagnosis of a hepatopancreaticobiliary (HPB) malignancy

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Abstract

Older patients are underrepresented in oncological clinical trials. The incidence of hepatopancreaticobiliary (HPB) malignancies is higher in older patients, but data on outcomes are lacking. This study assessed patient outcomes in those < 80 and ≥ 80 years with a HPB malignancy seen at a tertiary referral centre, The Christie NHS Foundation Trust. Data on patients with a HPB malignancy were collected retrospectively between 2012 and 2017 via on-line case-note review. Survival was calculated using the Kaplan–Meier method and prognostic factors using log-rank analysis. Of 1421 patients, 10% were ≥ 80 years. Of patients < 80 and ≥ 80 years, 56% and 57% had pancreas cancer, 39% and 36% biliary tract cancer, and 5% and 7% had hepatocellular carcinoma, respectively. Amongst patients ≥ 80 years, 75% had an Eastern Cooperative Oncology Group performance status (ECOG PS) 0–2. Patients ≥ 80 years had higher rates of comorbidity; 28% received systemic anti-cancer therapy (SACT), compared with 62% of patients < 80 years. Best supportive care (BSC) was instituted in 44% of older patients, compared with 13% in those < 80 years. Of patients ≥ 80 years who received SACT, 82% received monotherapy. Median overall survival (OS) for patients receiving palliative SACT was 10.07 months (95% CI 8.89–11.08) and 10.10 months (95% CI 6.30–12.30) in patients < 80 and ≥ 80 years, respectively, p 0.41; ECOG PS (p < 0.001) was prognostic for OS in older patients but Adult Comorbidity Evaluation-27 comorbidity score (p = 0.07, when comparing groups of ACE score ≤ 1 and > 1) was not. Baseline factors were similar in both age cohorts, but more comorbidities were present in older patients. Older patients were less likely to receive SACT, but when they did, they had an equivalent benefit in OS to younger patients.

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Author notes

  1. A. R. Lewis and C. Cipriano contributed equally to this manuscript.

Authors and Affiliations

  1. The Christie NHS Foundation Trust, Manchester, UK

    A. R. Lewis, X. Wang, R. Ward, A. Fitzpatrick, A. R. M. Scott, A. Rashed, H. Raja, A. Lamarca, R. A. Hubner, J. W. Valle & M. G. McNamara

  2. University of Manchester Medical School, Manchester, UK

    C. Cipriano

  3. Division of Cancer Sciences, University of Manchester, Manchester, UK

    J. W. Valle & M. G. McNamara

  4. Department of Medical Oncology/Division of Cancer Sciences, The Christie NHS Foundation Trust/University of Manchester, Manchester, M20 4BX, UK

    M. G. McNamara

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  1. A. R. Lewis
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  2. C. Cipriano
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Contributions

Initial manuscript preparation: LAR and CC. Study concepts and design: McMG, CC and LAR. Data Acquisition: LAR, CC, WR, FA, SA, RA, RH. Quality control of data and algorithms: MMG and LAR. Statistical analysis: WX. Data Analysis and interpretation: WX, LAR, CC, MMG. Manuscript editing: All authors. Manuscript review: LAR, CC, WX, WR, FA, SARM, RA, RH, LA, HRA, VJW, MMG.

Corresponding author

Correspondence to M. G. McNamara.

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Conflict of interest

Angela Lamarca received funding from ASCO Conquer Cancer Foundation Young Investigator Award and The Christie Charity. All authors declare no conflict of interest.

Ethical approval

This retrospective study was carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Clinical Audit Committee of The Christie NHS Foundation Trust (reference 17/1923).

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Lewis, A.R., Cipriano, C., Wang, X. et al. Outcomes in patients ≥ 80 years with a diagnosis of a hepatopancreaticobiliary (HPB) malignancy. Med Oncol 36, 85 (2019). https://doi.org/10.1007/s12032-019-1310-0

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