Is diabetes mellitus (DM) associated with worse outcomes in pancreatic cancer (PC)?

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4114 Background: Previous studies suggest that patients with DM have worse oncologic outcomes than those who do not. To address this issue in PC, we performed a systematic review of a large cancer database. Methods: The Veterans Affairs (VA) Central Cancer Registry (VACCR) aggregates cancer data from more than 120 VA centers across the United States. We queried the VACCR for PC cases between 1995 and 2008, and cases with DM were identified. Data were analyzed using biostatistical software SPSS. Kaplan-Meier curves were used for estimates of overall survival (OS) and chi square for comparison of categorical variables. Results: There were 8,466 cases of PC identified. Comorbidity data was available for 4,728 cases and DM was present in 1,326 (28%). Males comprised 97.7% while 77.3% were white. Two groups were similar in race, sex, and primary site. OS in DM was 4.2 vs. 3.6 months (mo) in non-DM (p=0.048). OS between DM and non-DM was 6.7 vs. 6.5 mo (p=0.5) for early stage and 2.5 vs. 2.1 mo for stage 4 (p=0.02). DM cases were more likely to receive chemotherapy and radiation (37.9% vs. 33.5% and 15.2% vs. 12.2% (see Table). Cox regression analysis revealed DM, age, race, site, gender, stage, chemotherapy, surgery, were independent predictors of survival while radiation was not. Conclusions: According to this retrospective review, PC patients with DM do not have worse OS than non-DM in the VA system. We suggest evaluating this association in a large prospective fashion. Diabetics (n=1,326) Nondiabetics (n=3,402) p value Age (years) 67.8 66.9 0.01 Stage 0 n (%) 2 (0.2) 8 (0.3) 0.06 1 8 (0.8) 35 (1.3) 2 8 (0.8) 42 (1.6) 3 137 (13.7) 334 (12.7) 4 635 (63.3) 1,563 (59.6) Missing 213 (30.2) 641 (24.4) Sex Male 1,295 (97.7) 3,322 (97.6) 0.9 Female 31 (2.3) 80 (2.4) Race White 1,053 (79.4) 2,636 (77.5) 0.3 Black 240 (18.1) 680 (20) Other 33 (2.5) 86 (2.5) Site Head 707 (53.3) 1,745 (51.3) 0.132 Body 151 (11.4) 327 (9.6) Tail 154 (11.6) 419 (12.3) Missing/Other 314 (23.7) 911 (26.8) Rx Chemo Yes 37.9% 33.5% 0.005 No 62.1% 66.5% Radiation Yes 15.2% 12.2% 0.006 No 84.8% 87.8% Surgery Yes 15.6% 15.5% 0.9 No 84.4% 84.5% Survival (mo) p; Median 4.2 3.5 0.048 Stage 1-3 6.7 6.5 0.5 Stage 4 2.5 2.1 0.02 12-mo (%) 8.4 8.3 18-mo (%) 5.4 4.8 No significant financial relationships to disclose.