Impact of diabetes and insulin use on prognosis in patients with resected pancreatic cancer: An ancillary analysis of NRG Oncology RTOG 9704 Journal Article


Authors: Bitterman, D. S.; Winter, K. A.; Hong, T. S.; Fuchs, C. S.; Regine, W. F.; Abrams, R. A.; Safran, H.; Hoffman, J. P.; Benson, A. B. 3rd; Kasunic, T.; Mulcahy, M.; Strauss, J. F.; DiPetrillo, T.; Stella, P. J.; Chen, Y.; Plastaras, J. P.; Crane, C. H.
Article Title: Impact of diabetes and insulin use on prognosis in patients with resected pancreatic cancer: An ancillary analysis of NRG Oncology RTOG 9704
Abstract: Purpose: Diabetes mellitus (DM) has been proposed to be tumorigenic; however, prior studies of the association between DM and survival are conflicting. The goal of this ancillary analysis of RTOG 9704, a randomized controlled trial of adjuvant chemotherapy in pancreatic cancer, was to determine the prognostic effects of DM and insulin use on survival. Methods and Materials: Eligible patients from RTOG 9704 with available data on DM and insulin use were included. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, and variable levels were compared using log-rank test. Cox proportional hazards models were created to assess the associations among DM, insulin use, and body mass index phenotypes on outcomes. Results: Of 538 patients enrolled from 1998 to 2002, 238 patients were eligible with analyzable DM and insulin use data. Overall 34% of patients had DM and 66% did not. Of patients with DM, 64% had insulin-dependent DM, and 36% had non–insulin-dependent DM. On univariable analysis, neither DM nor insulin dependence were associated with OS or DFS (P >.05 for all). On multivariable analysis, neither DM, insulin use, nor body mass index were independently associated with OS or DFS. Nonwhite race (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.35-3.50; P =.0014), nodal involvement (HR, 1.74; 95% CI, 1.24-2.45; P =.0015), and carbohydrate antigen 19-9 (CA19-9) ≥90 U/mL (HR, 3.61; 95% CI, 2.32-5.63; P <.001) were associated with decreased OS. Nonwhite race (HR, 1.67; 95% CI, 1.05-2.63; P =.029) and CA19-9 ≥90 U/mL (HR, 2.86; 95% CI, 1.85-4.40; P <.001) were associated with decreased DFS. Conclusions: DM and insulin use were not associated with OS or DFS in patients with pancreatic cancer in this study. Race, nodal involvement, and increased CA19-9 were significant predictors of outcomes. These data might apply to the more modern use of neoadjuvant therapies for potentially resectable pancreatic cancer. © 2020 Elsevier Inc.
Keywords: adult; cancer survival; controlled study; aged; disease-free survival; major clinical study; overall survival; fluorouracil; gemcitabine; disease free survival; neoadjuvant therapy; chemotherapy; follow up; prospective study; phenotype; randomized controlled trial; ca 19-9 antigen; obesity; confidence interval; body mass; adjuvant chemotherapy; diagnosis; pancreas adenocarcinoma; insulin; insulin dependent diabetes mellitus; race difference; non insulin dependent diabetes mellitus; diseases; hazards; cancer prognosis; multivariable analysis; methods and materials; human; male; female; priority journal; article; cox proportional hazards models
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 109
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2021-01-01
Start Page: 201
End Page: 211
Language: English
DOI: 10.1016/j.ijrobp.2020.08.042
PUBMED: 32858111
PROVIDER: scopus
PMCID: PMC7736166
DOI/URL:
Notes: Article -- Export Date: 1 February 2021 -- Source: Scopus
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  1. Christopher   Crane
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