Inflammatory, insulin resistance metabolic markers and pancreatic cancer: quo vadis? [corrected

Abstract

Pancreatic cancer is an aggressive and often fatal malignancy with an overall mortality to incidence ratio of 0.98. In 2012, 338,000 new cases were diagnosed worldwide and 330,000 deaths were recorded [1]. In the USA, pancreatic cancer is currently the fourth leading cause of cancer death, but it is projected to become the second leading cause before 2020 [2]. The 5-year survival rate (<5%) is lower than that of all other major cancers. Standard treatment is cytotoxic chemotherapy, which can be effective, but disease progression generally ensues within 6–12 months. The only potentially curative therapy is surgery, but less than 20% of patients are candidates for surgery and among those who undergo surgery, the 5-year survival rate is 15%, highlighting the fact that the vast majority of patients have occult metastatic disease at the time of presentation. Population-based screening programs for pancreatic cancer are not feasible owing to the very low absolute individual risk, as well as the lack of non invasive and low-cost screening tools. Hence, identifying biomarkers of risk that could be useful in high-risk individuals is essential. o besity, diabetes & pancreatic cancer There is compelling data linking obesity and diabetes with pancreatic cancer risk and survival [3,4]. Obese individuals with a BMI of ≥35.0 have a significant increased risk of pancreatic cancer compared with individuals with normal weight (BMI: 18.5–24.9). Furthermore, every 5 kg/m 2 increase in BMI is associated with a 12% increased risk of pancreatic cancer [5]. The association of obesity with pancreatic cancer risk is not limited to obesity during adult life, as obesity during adolescence and early adulthood also confer increased risk. Likewise, the association of diabetes with pancreatic cancer risk is established [6]. In a meta-analysis of cohort studies, diabetes was associated with a 1.94-fold increased risk of pancreatic cancer [6]. A challenge in epidemiological studies investigating the association of diabetes with pancreatic cancer risk is the concept of reverse causality. Pancreatic cancer causes diabetes, and an estimated 34% of pancreatic cancer patients may have pancreatic cancer-induced diabetes [7], hence, onset and duration of diabetes are