title: Obesity adversely affects survival in pancreatic cancer patients.
abstract: BACKGROUND
  Higher body-mass index (BMI) has been implicated as a risk factor for developing pancreatic cancer, but its effect on survival has not been thoroughly investigated. The authors assessed the association of BMI with survival in a sample of pancreatic cancer patients and used epidemiologic and clinical information to understand the contribution of diabetes and hyperglycemia.
  
  
  METHODS
  A survival analysis using Cox proportional hazards by usual adult BMI was performed on 1861 unselected patients with pancreatic adenocarcinoma; analyses were adjusted for covariates that included clinical stage, age, and sex. Secondary analyses incorporated self-reported diabetes and fasting blood glucose in the survival model.
  
  
  RESULTS
  BMI as a continuous variable was inversely associated with survival from pancreatic adenocarcinoma (hazard ratio [HR], 1.019 for each increased unit of BMI [kg/m2], P<.001) after adjustment for age, stage, and sex. In analysis by National Institutes of Health BMI category, BMIs of 30 to 34.99 kg/m2 (HR, 1.14; 95% confidence interval [CI], 0.98-1.33), 35 to 39.99 kg/m2 (HR 1.32, 95% CI 1.08-1.62), and ≥40 (HR 1.60, 95% CI 1.26-2.04) were associated with decreased survival compared with normal BMI of 18.5 to 24.99 kg/m2 (overall trend test P<.001). Fasting blood glucose and diabetes did not affect the results.
  
  
  CONCLUSIONS
  Higher BMI is associated with decreased survival in pancreatic cancer. Although the mechanism of this association remains undetermined, diabetes and hyperglycemia do not appear to account for the observed association.
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905, USA. mcwilliams.robert@mayo.edu
authors.forename: Robert R
authors.initials: RR
authors.lastname: McWilliams
authors.forename: Martha E
authors.initials: ME
authors.lastname: Matsumoto
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Burch
authors.forename: George P
authors.initials: GP
authors.lastname: Kim
authors.forename: Thorvardur R
authors.initials: TR
authors.lastname: Halfdanarson
authors.forename: Mariza
authors.initials: M
authors.lastname: de Andrade
authors.forename: Kaye
authors.initials: K
authors.lastname: Reid-Lombardo
authors.forename: William R
authors.initials: WR
authors.lastname: Bamlet
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality*; D012307:Risk Factors