Surgically resected early-onset pancreatic cancer shows worse outcomes and aggressive molecular features compared to late-onset cases.

• Patients under 50 had a median disease-free survival of 10.9 months versus 14.2 months for those 50 and older (p = 0.011).
• More young patients received adjuvant chemotherapy, yet their disease-free survival was shorter at 12.6 months vs. 16.0 months (p = 0.022).

Surgeons should consider aggressive monitoring and tailored treatment strategies for younger pancreatic cancer patients due to these poorer outcomes.

• Early-onset cases show increased genes for aggressive pathology, including S100A2 and TP63.