TY - JOUR
T1 - Impact of Diabetes and Insulin Use on Prognosis in Patients With Resected Pancreatic Cancer
T2 - An Ancillary Analysis of NRG Oncology RTOG 9704
AU - Bitterman, Danielle S.
AU - Winter, Kathryn A.
AU - Hong, Theodore S.
AU - Fuchs, Charles S.
AU - Regine, William F.
AU - Abrams, Ross A.
AU - Safran, Howard
AU - Hoffman, John P.
AU - Benson, Al B.
AU - Kasunic, Timothy
AU - Mulcahy, Mary
AU - Strauss, James F.
AU - DiPetrillo, Thomas
AU - Stella, Philip J.
AU - Chen, Yuhchyau
AU - Plastaras, John P.
AU - Crane, Christopher H.
N1 - Funding Information:
This project was supported by grants U10CA180868 ( NRG Oncology Operations ), U10CA180822 ( NRG Oncology SDMC ), U10CA180820 ( ECOG-ACRIN ), and U10CA180888 ( SWOG ) from the National Cancer Institute (NCI) and Eli Lilly and Company. This project is funded, in part, under a grant from the Pennsylvania Department of Health . The department specifically disclaims responsibility for any analyses, interpretations, or conclusions.
Funding Information:
Disclosures: A.B.B. reports an advisor role with Envision, Guardant, DavaOnc, LSK, Therabionic, PreCOG, Terumo, Lexicon, Incyte, ACCC, and ECOG-ACRIN; a Data Monitor Committee role with Bristol-Myers Squibb; research with Acerta, Celgene, Advanced Accelerator Applications, Novartis, Infinity Pharmaceuticals, Merck Sharp and Dohme, Talho Pharmaceutical, Bristol-Myers Squibb, Medimmune/AstraZeneca, Xencor, and Amgen; and other with NCCN, outside the submitted work. D.S.B. reports personal fees from Agios Pharmaceuticals, outside the submitted work; D.S.B.’s spouse is an employee at Agios Pharmaceuticals. Y.C. reports institutional grant funding from National Cancer Institute to RTOG for clinical trial case enrollment during the conduct of the study. C.S.F. reports personal fees from Agios, Bain Capital, Bayer, Celgene, Dicerna, Eli Lilly, Five Prime Therapeutics, Genentech, Gilead Sciences, KEW, Merck, Merrimack, Pfizer, Sanofi, Talho, and Unum, and personal fees and other from CytomX and Entrinsic Health, outside the submitted work. J.F.S. reports stock and other ownership interests from Abbvie, Abbott Laboratories, Bristol-Myers Squibb, Intuitive Surgical, Johnson & Johnson, and Merck; a consulting or advisory role with Tempus; and other relationships with Dialectic Therapeutics.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ijrobp.2020.08.042
DO - 10.1016/j.ijrobp.2020.08.042
M3 - Article
C2 - 32858111
AN - SCOPUS:85091879586
SN - 0360-3016
VL - 109
SP - 201
EP - 211
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 1
ER -
