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Bitterman DS , Winter KA , Hong TS , Fuchs CS , Regine WF , Abrams RA , Safran H , Hoffman JP , Benson AB 3rd , Kasunic T , Mulcahy M , Strauss JF , DiPetrillo T , Stella PJ , Chen Y , Plastaras JP , Crane CH
Impact of diabetes and insulin use on prognosis in patients with resected pancreatic cancer: an ancillary analysis of NRG Oncology RTOG 9704
Int J Radiat Oncol Biol Phys. 2021 Jan;109(1) :201-211
PMID: 32858111    PMCID: PMC7736166    URL: https://www.ncbi.nlm.nih.gov/pubmed/32858111
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PURPOSE: Diabetes mellitus (DM) has been proposed to be tumorigenic however, prior studies of the association between DM and survival are conflicting. The goal of this ancillary analysis of XXXX, a randomized controlled trial of adjuvant chemotherapy in pancreatic cancer, was to determine the prognostic impact of DM and insulin use on survival. PATIENTS AND METHODS: Eligible patients from XXXX with available data on DM and insulin use were included. Overall survival (OS) and disease-free survival (DFS) were estimated by Kaplan-Meier method and variable levels were compared using log-rank test. Cox proportional hazards models were created to assess the association between DM, insulin use, and body mass index (BMI) phenotypes on outcomes. RESULTS: Of 538 patients enrolled from 1998-2002, 238 patients were eligible with analyzable DM and insulin use data. Overall 34% of patients had DM and 66% did not. Of patients with DM, 64% had insulin dependent DM, and 36% had non-insulin dependent DM. On univariable analysis, neither DM nor insulin dependence were associated with OS or DFS (P>0.05 for all). On multivariable analysis, neither DM, insulin use, nor BMI were independently associated with OS or DFS. Non-white race (HR 2.18, 95% confidence interval (CI) 1.35-3.50, P=0.0014), nodal involvement (HR 1.74, 95% CI 1.24-2.45, P=0.0015), and carbohydrate antigen 19-9 (CA19-9) ≥ 90 U/mL (HR 3.61, 95% CI 2.32-5.63, P<0.001) were associated with decreased OS. Non-white race (HR 1.67, 95% CI 1.05-2.63, P=0.029) and CA19-9 ≥ 90 U/mL (HR 2.86, 95% CI 1.85-4.40, P<0.001) were associated with decreased DFS. CONCLUSIONS: DM and insulin use were not associated with OS or DFS in patients with pancreatic cancer in this study. Race, nodal involvement, and increased CA19-9 were significant predictors of outcomes. These data may or may not apply to the more modern use of neoadjuvant therapies for potentially resectable pancreatic cancer.
1879-355x Bitterman, Danielle S Winter, Kathryn A Hong, Theodore S Fuchs, Charles S Regine, William F Abrams, Ross A Safran, Howard Hoffman, John P Benson, Al B 3rd Kasunic, Timothy Mulcahy, Mary Strauss, James F DiPetrillo, Thomas Stella, Philip J Chen, Yuhchyau Plastaras, John P Crane, Christopher H Journal Article United States Int J Radiat Oncol Biol Phys. 2020 Aug 25:S0360-3016(20)34137-7. doi: 10.1016/j.ijrobp.2020.08.042.