Diabetes and pancreatic cancer survival: a prospective cohort-based study.
BACKGROUND
Diabetes is a risk factor for pancreatic cancer but its association with survival from pancreatic cancer is poorly understood. Our objective was to investigate the association of diabetes with survival among pancreatic cancer patients in a prospective cohort-based study where diabetes history was ascertained before pancreatic cancer diagnosis.


METHODS
We evaluated survival by baseline (1993-2001) self-reported diabetes history (n=62) among 504 participants that developed exocrine pancreatic cancer within the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using Cox proportional hazards model, adjusted for age, sex, body mass index, race, smoking, and tumour stage (local, locally advanced, and metastatic).


RESULTS
The multivariable-adjusted HR for mortality comparing participants with diabetes to those without was 1.52 (95% CI=1.14-2.04, P-value <0.01). After excluding those diagnosed with pancreatic cancer within 3 years of study enrolment, HR for mortality among those with diabetes was 1.45 (95% CI=1.06-2.00, P-value=0.02).


CONCLUSIONS
Using prospectively collected data, our findings indicate that diabetes is associated with worse survival among patients with pancreatic cancer.
Department of Surgery, Division of Public Health Sciences, Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St Louis, MO 63144, USA.
A T
AT
Toriola
Branch of Nutritional Epidemiology, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9609 Medical Center Drive, Room 6E420, Rockville, MD 20850, USA.
R
R
Stolzenberg-Solomon
Department of Surgery, Division of Public Health Sciences, Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St Louis, MO 63144, USA.
L
L
Dalidowitz
Department of Surgery, Section of Hepato-Pancreatico-Biliary and Gastrointestinal Surgery, Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St Louis, MO 63144, USA.
D
D
Linehan
Department of Surgery, Division of Public Health Sciences, Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St Louis, MO 63144, USA.
G
G
Colditz
D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology