Abstract
IntroductionDiabetes mellitus (DM) has the potential to impact the pathogenesis, treatment, and outcome of pancreatic cancer. This study evaluates the impact of DM on pancreatic cancer survival.MethodsWe conducted a retrospective cohort study from the Veterans Affairs (VA) Central Cancer Registry (VACCR) for pancreatic cancer cases between 1995 and 2008. DM and no-DM cases were identified from comorbidity data. Univariate and multivariable analysis was performed. Multiple imputation method was employed to account for missing variables.ResultsOf 8,466 cases of pancreatic cancer DM status was known in 4728 cases that comprised this analysis. Males accounted for 97.7% cases, and 78% were white. Overall survival was 4.2 months in DM group and 3.6 months in the no-DM group. In multivariable analysis, DM had a HR = 0.91 (0.849–0.974). This finding persisted after accounting for missing variables using multiple imputations method with the HR in DM group of 0.93 (0.867–0.997).ConclusionsOur data suggest DM is associated with a reduction in risk of death in pancreatic cancer. Future studies should be directed towards examining this association, specifically impact of DM medications on cancer outcome.
Highlights
Diabetes mellitus (DM) has the potential to impact the pathogenesis, treatment, and outcome of pancreatic cancer
Insulin resistance can lead to increased muscle proteolysis and contribute to inhibition of protein anabolism which can result in cachexia, a syndrome characterized by significant loss of adipose and skeletal muscle tissue [5,6]
To determine if missing data was missing at random (MAR) we evaluated Tetrachoric Correlation and Pearson correlation between missing variables and other variables included in the multivariable model
Summary
Diabetes mellitus (DM) has the potential to impact the pathogenesis, treatment, and outcome of pancreatic cancer. Pancreatic cancer is a cause of significant morbidity and mortality and effective treatment strategies are lacking. DM is a recognized risk factor for the development of pancreatic cancer [4]. The development of DM in patients with pancreatic cancer is likely secondary to a combination of factors leading to a marked decline in pancreatic b cell function and profound peripheral insulin resistance. Pancreatic cancer patients with cachexia are less likely to undergo curative surgery and have increased postoperative mortality [4,7]. The etiology of diabetes, impact of insulin resistance related cachexia, as well as DM treatment, has the potential to impact pancreatic cancer outcome
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