Baseline hemoglobin-A1c impacts clinical outcomes in patients with pancreatic cancer.
An association between diabetes mellitus and pancreatic ductal adenocarcinoma (PDA) has long been recognized. This article assesses the effect of the baseline hemoglobin-A1c (HbA1c) value on the clinical outcomes of patients with PDA. HbA1c values were prospectively collected on 656 consecutive patients presenting to a pancreas multidisciplinary cancer clinic from 2009 to 2012. Patients were diagnosed with benign pancreatic disease (BPD) or biopsy-confirmed resectable (R), borderline/locally advanced (BL), or metastatic (M) PDA. Excluded were those with prior treatment for PDA or a history of chronic diabetes mellitus (>1-year or unknown duration), resulting in a final cohort of 284 patients. Of 284 patients, 44 had benign disease, 62 had R-PDA, 115 had BL-PDA, and 63 had M-PDA. Patients with malignant disease (R-, BL-, and M-PDA) collectively had a higher average HbA1c value than patients with BPD (6.1% vs 5.6%; P<.001). Among patients with PDA (n=240), HbA1c values of 6.5% or greater were significantly associated with inferior overall survival (OS) compared with patients with HbA1c values less than 6.5% (hazard ratio [HR], 1.74; OS, 10.2 vs 13.0 months; P=.007), along with other known prognostic factors, such as age of 65 years or older, ECOG performance status of 1 or greater, carbohydrate antigen 19-9 level greater than 90, tumor size larger than 3 cm, and disease stage. HbA1c values of 6.5% or greater remained in the final predictive model using backward elimination (HR, 1.46; P=.097), indicating that HbA1c values of 6.5% or greater influence OS of patients with PDA even when accounting for other known prognostic factors. HbA1c level at presentation is significantly higher in patients with PDA than patients with BPD and seems to affect survival.
From the aDepartment of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; bDepartment of Statistics, Stanford University, Palo Alto, California; cDepartment of Radiation Oncology, University of California San Francisco, San Francisco, California; and dDepartment of Oncology, Sidney Kimmel Comprehensive Cancer Center, eDepartment of Pathology, The Sol Goldman Pancreatic Cancer Research Center, fRussell H. Morgan Department of Radiology and Radiological Sciences, gDivision of Endocrinology and Metabolism, Department of Internal Medicine, and hDepartment of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Katherine Y
KY
Fan
Avani S
AS
Dholakia
Aaron T
AT
Wild
Zheng
Z
Su
Amy
A
Hacker-Prietz
Rachit
R
Kumar
Mary
M
Hodgin
Charles C
CC
Hsu
Dung T
DT
Le
Ana
A
De Jesus-Acosta
Luis A
LA
Diaz
Daniel A
DA
Laheru
Ralph H
RH
Hruban
Elliot K
EK
Fishman
Todd D
TD
Brown
Timothy M
TM
Pawlik
Christopher L
CL
Wolfgang
Phuoc T
PT
Tran
Joseph M
JM
Herman
D000230:Adenocarcinoma / Q000097:blood* / Q000473:pathology* / Q000628:therapy; D000368:Aged; D048909:Diabetes Complications / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000473:pathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D016019:Survival Analysis
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human