Survival among patients with pancreatic cancer and long-standing or recent-onset diabetes mellitus.
OBJECTIVE
Long-standing diabetes is a risk factor for pancreatic cancer, and recent-onset diabetes in the several years before diagnosis is a consequence of subclinical pancreatic malignancy. However, the impact of diabetes on survival is largely unknown.


METHODS
We analyzed survival by diabetes status among 1,006 patients diagnosed from 1986 to 2010 from two prospective cohort studies: the Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). We validated our results among 386 patients diagnosed from 2004 to 2013 from a clinic-based case series at Dana-Farber Cancer Institute (DFCI). We estimated hazard ratios (HRs) for death using Cox proportional hazards models, with adjustment for age, sex, race/ethnicity, smoking, diagnosis year, and cancer stage.


RESULTS
In NHS and HPFS, HR for death was 1.40 (95% CI, 1.15 to 1.69) for patients with long-term diabetes (> 4 years) compared with those without diabetes (P < .001), with median survival times of 3 months for long-term diabetics and 5 months for nondiabetics. Adjustment for a propensity score to reduce confounding by comorbidities did not change the results. Among DFCI patient cases, HR for death was 1.53 (95% CI, 1.07 to 2.20) for those with long-term diabetes compared with those without diabetes (P = .02), with median survival times of 9 months for long-term diabetics and 13 months for nondiabetics. Compared with nondiabetics, survival times were shorter for long-term diabetics who used oral hypoglycemics or insulin. We observed no statistically significant association of recent-onset diabetes (< 4 years) with survival.


CONCLUSIONS
Long-standing diabetes was associated with statistically significantly decreased survival among patients with pancreatic cancer enrolled onto three longitudinal studies.
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Chen
C
Yuan
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Douglas A
DA
Rubinson
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Zhi Rong
ZR
Qian
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Chen
C
Wu
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Peter
P
Kraft
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Ying
Y
Bao
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Shuji
S
Ogino
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Kimmie
K
Ng
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Thomas E
TE
Clancy
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Richard S
RS
Swanson
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Megan J
MJ
Gorman
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Lauren K
LK
Brais
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Tingting
T
Li
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Meir J
MJ
Stampfer
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Frank B
FB
Hu
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Edward L
EL
Giovannucci
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Matthew H
MH
Kulke
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Charles S
CS
Fuchs
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. bwolpin@partners.org.
Brian M
BM
Wolpin
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology