Long-Term Diabetes Associated With Increased Mortality in Pancreas Cancer
In a study reported in the Journal of Clinical Oncology, Yuan et al found that pancreas cancer patients with diabetes of more than 4 years’ duration at diagnosis had significantly poorer survival compared with nondiabetic patients.
Study Details
The study involved data from 1,006 patients diagnosed with pancreas cancer between 1986 to and 2010 in the Nurses’ Health Study (NHS; n = 635) and Health Professionals Follow-Up Study (HPFS; n = 371) and from 386 patients diagnosed between 2004 and 2013 in a clinic-based case series at Dana-Farber Cancer Institute (DFCI). Hazard ratios for death were estimated using Cox proportional hazards models with adjustment for age, sex, race/ethnicity, smoking, diagnosis year, and cancer stage.
NHS/HPFS Cohort
In the NHS/HPFS cohort, there were 793 deaths in 825 patients without diabetes over 8,544 person-months of follow-up, 47 deaths in 47 patients with short-term diabetes (≤ 4 years) over 441 person-months, and 131 deaths in 134 patients with long-term diabetes (> 4 years) over 873 person-months. Median overall survival was 5, 6, and 3 months. On multivariate analysis, the hazard ratio for death was 1.40 (P < .001) for patients with long-term diabetes and 1.03 (P = .84) for those with short-term diabetes vs nondiabetic patients.
DFCI Cohort
In the DFCI cohort, there were 179 deaths in 265 patients without diabetes over 4,185 person-months, 51 deaths in 72 patients with short-term diabetes over 995 person-months, and 38 deaths in 49 patients with long-term diabetes over 508 person-months. Median overall survival was 13, 11, and 9 months. On multivariate analysis, hazard ratios for death were 1.53 (P = .02) for patients with long-term diabetes and 1.22 (P = .23) for those with short-term diabetes vs nondiabetic patients.
The investigators concluded: “Long-standing diabetes was associated with statistically significantly decreased survival among patients with pancreatic cancer enrolled onto three longitudinal studies…. These data demonstrate a link between chronic glucose intolerance and pancreatic cancer survival, while suggesting that recent-onset diabetes does not portend a worse prognosis among patients with pancreatic adenocarcinoma.”
Brian M. Wolpin, MD, MPH, of Dana-Farber Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article. Chen Yuan, MS, and Douglas A. Rubinson, MD, PhD, of Dana-Farber Cancer Institute, contributed equally to the study.
The study was supported by the National Cancer Institute, Robert T. and Judith B. Hale Fund for Pancreatic Cancer Research, Lustgarten Foundation, American Society of Clinical Oncology Conquer Cancer Foundation, Howard Hughes Medical Institute, and Promises for Purple. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
