The impact of diabetes mellitus and metformin on survival of patients with advanced pancreatic cancer receiving chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4044-4044
Author(s):  
Do-Youn Oh ◽  
Younak Choi ◽  
Tae-Yong Kim ◽  
Kyung-Hun Lee ◽  
Sae-Won Han ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Pancreatic Cancer ◽  
Clinical Characteristics ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
Disease Status ◽  
Antidiabetic Medication ◽  
Recent Onset ◽  
The Impact ◽  
Positive Effect

4044 Background: A causal relationship between diabetes mellitus (DM) and pancreatic cancer (PC) is well established. However, in patients with advanced PC (APC) who receive palliative chemotherapy, the impact of DM on prognosis is unclear. Methods: Between 2003 and 2010, we enrolled consecutive patients with APC, all recipients of palliative chemotherapy, with the provision that DM disease status could be properly defined. Enrollees were stratified by diagnosis, in accordance with 2010 DM criteria (AHA/ADA). DM at least 2 years' duration prior to diagnosis of APC qualified as remote-onset DM (vs recent-onset). Clinical characteristics and outcomes were then analyzed. Results: Of the 349 enrollees with APC, 183 (52.4%) had DM. In patients with DM, 160 had DM at the time APC was diagnosed (remote onset, 87; recent onset, 73); and the remaining 23 developed DM during the course of APC treatment. Ultimately, 73.2% (134/183) of DM patients received antidiabetic medication (metformin (56), sulfonylurea (62), insulin (43)). By multivariate analysis, cancer extent (HR, 1.792; p < 0.001) and weight loss during chemotherapy (HR, 1.270; p = 0.08) were associated with diminished overall survival (OS), whereas a diagnosis of DM (HR, 0.788; p = 0.05) conferred a positive effect on OS ( OS 8.4 months in DM patients vs 7.5 months in non-DM patients, p = 0.04). Among DM patients, recent-onset DM trended toward prolonged OS, compared with remote-onset/subsequent DM (9.8 months vs. 7.9 months, respectively; HR, 0.789; p = 0.142). Neither antidiabetic medication in general nor sulfonylurea or insulin specifically affected OS. However, recipients of metformin survived longer than non-recipients (HR, 0.693; 95% CI, 0.492-0.977; p = 0.036). Relative to the APC cohort overall including non-DM patients, metformin conferred better survival as well (11.0 months vs. 7.8 months, HR 0.712, p = 0.067), given similar baseline clinical characteristics. Conclusions: In patients with APC receiving palliative chemotherapy, recent-onset DM (within 2 years of APC diagnosis) and metformin treatment are positive prognosticators, associated with prolonged OS.

The impact of body mass index dynamics on survival of patients with advanced pancreatic cancer receiving chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15066-e15066
Author(s):  
Younak Choi ◽  
Do-Youn Oh ◽  
Tae-Yong Kim ◽  
Kyung-Hun Lee ◽  
Sae-Won Han ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Clinical Characteristics ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
High Body Mass Index ◽  
Good Health ◽  
Increased Risk ◽  
The Impact

e15066 Background: The obesity is increasing worldwide. High body mass index (BMI) is linked with an increased risk of developing pancreatic cancer (PC). However, in patients with advanced PC (APC), especially those are receiving palliative chemotherapy (the majority of all PC patients), the impact of BMI and its change during disease course on survival has not been fully investigated. Methods: Consecutive patients with APC were enrolled during years 2003-2010, all treated with palliative chemotherapy. The BMI measured at the point of starting the first cycle of palliative chemotherapy was called as “BMI at diagnosis”. “Pre-cancer weight” which means the weight in good health was the sum of “weight at diagnosis” and “weight loss at diagnosis” that the patients’ self- reported at the first visit. “Pre-cancer BMI” was calculated using pre-cancer weight. We got weight data measured at every visit during chemotherapy to investigate BMI change during chemotherapy period. Clinical characteristics and outcomes were analyzed. Results: A total of 425 patients were enrolled (median age, 60.1 years). At diagnosis of APC, the BMI distribution of patients was as follows: <18.5 (45, 10.6%); 18.5-19.9 (67, 15.8%); 20.0-22.4 (156, 36.7%); 22.5-24.9 (107, 25.2%); 25.0-29.9 (49, 11.5%); and ≥30.0 (1, 0.2%). Clinical characteristics were balanced across BMI groups. Median overall survival (OS) was 8.1 months (95% CI, 7.2-9.1). Pre-cancer BMI and BMI at diagnosis had no impact on OS (p = 0.488, p = 0.348, respectively), although patients at BMI range of 22.5-24.9 achieved the longest OS (9.9 months; 95% CI, 8.5-11.3). BMI loss at diagnosis (pre-cancer BMI minus BMI at the diagnosis) and BMI loss during chemotherapy (both stipulated as BMI change ≥1) were associated with shortened OS (HR, 1.300; p = 0.012 and HR, 1.367; p= 0.010, respectively). Conclusions: In patients with APC undergoing palliative chemotherapy, both declines in BMI at diagnosis of APC and during chemotherapy are more hazardous for OS than pre-cancer BMI or BMI at diagnosis itself as absolute values. Further research evaluating strategies to maintain BMI during chemotherapy in this setting is thus warranted.

scholarly journals The Impact of Diabetes Mellitus and Metformin Treatment on Survival of Patients with Advanced Pancreatic Cancer Undergoing Chemotherapy

2016 ◽  
Vol 48 (1) ◽  
pp. 171-179 ◽  
Author(s):  
Younak Choi ◽  
Tae-Yong Kim ◽  
Do-Youn Oh ◽  
Kyung-Hun Lee ◽  
Sae-Won Han ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Pancreatic Cancer ◽  
Advanced Pancreatic Cancer ◽  
Metformin Treatment ◽  
The Impact

scholarly journals Neutrophil-to-lymphocyte ratio for predicting palliative chemotherapy outcomes in advanced pancreatic cancer patients.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 186-186 ◽  
Author(s):  
Peng Xue ◽  
Masashi Kanai
Keyword(s):  
Pancreatic Cancer ◽  
Prognostic Factor ◽  
Treatment Outcomes ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Group A ◽  
Group B ◽  
The Impact

186 Background: Several previous studies reported neutrophil-to-lymphocyte ratio (NLR) could be a promising prognostic factor for patients with cancer. We aimed to determine the prognostic value of NLR in patients with advanced pancreatic cancer (APC) following palliative chemotherapy. Methods: We retrospectively reviewed 253 consecutive APC patients receiving palliative chemotherapy between January 2006 and December 2012. We classified the patients according to the pretreatment NLR values (≤5 or >5) into two groups and investigated the difference in treatment outcomes, including time to treatment failure (TTF) and overall survival (OS); and also analyzed the impact of NLR kinetics after one cycle of chemotherapy on the treatment outcomes. Results: A total of 213 patients had pretreatment NLR values of ≤5 (group A), while 40 patients had an NLR of >5 (group B). TTF and OS were significantly shorter in group B than in group A (3.1 vs. 6.0 months and 8.8 vs. 12.8 months, respectively). After adjustment for putative prognostic factors, including distant metastasis, status of recurrent/unresectable disease, pretreatment carbohydrate antigen 19-9 levels, carcinoembryonic antigen levels, and C-reactive protein levels, using the Cox regression model, elevated pretreatment NLR remained an independent poor prognostic factor for OS (hazard ratio, 1.95; 95% confidence interval, 1.29–2.95; P <0.01). In addition, patients in group B whose NLR dropped to ≤5 before the second cycle of chemotherapy showed longer TTF and OS compared with those whose NLR remained at >5. Conclusions: Our results support the idea that NLR can be a promising prognostic and predictive marker for APC patients receiving palliative chemotherapy.

scholarly journals Survival Among Patients With Pancreatic Cancer and Long-Standing or Recent-Onset Diabetes Mellitus

2015 ◽  
Vol 33 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Chen Yuan ◽  
Douglas A. Rubinson ◽  
Zhi Rong Qian ◽  
Chen Wu ◽  
Peter Kraft ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Median Survival ◽  
Case Series ◽  
Health Study ◽  
Survival Times ◽  
Recent Onset ◽  
Onset Diabetes ◽  
Diabetes Status ◽  
The Impact

Purpose 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. Patients and 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. Conclusion Long-standing diabetes was associated with statistically significantly decreased survival among patients with pancreatic cancer enrolled onto three longitudinal studies.

scholarly journals Diabetes mellitus and chronic liver diseases. Literature review (part 2): treatment features

2019 ◽  
Vol 91 (12) ◽  
pp. 115-121
Author(s):  
Z A Kalmykova ◽  
I V Kononenko ◽  
A Yu Mayorov
Keyword(s):  
Diabetes Mellitus ◽  
Carbohydrate Metabolism ◽  
Drug Effects ◽  
Chronic Liver ◽  
Impaired Liver Function ◽  
Pathological Conditions ◽  
Impaired Liver ◽  
Relationship Of ◽  
The Impact ◽  
Positive Effect

Diabetes mellitus (DM) and chronic liver disease (CLD) are pathological conditions associated with each other and reaching epidemic proportions. There is a strong pathogenetic relationship of carbohydrate metabolism disorders and a number of CLD. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various CLD, leading to steatosis, insulin resistance (IR), impaired glucose tolerance and the development of DM are described. Effective glycemic control can have a beneficial effect on the treatment of these patients, and, conversely, there is evidence of a positive effect of CLD therapy on carbohydrate metabolism. This review discusses the correction of carbohydrate metabolism in patients with CLD, the main groups of modern hypoglycemic drugs, mechanisms of their action, the impact on the physiology of the liver, the possibility of using each of these pharmacological groups in patients with impaired liver function. The modern approaches and possibilities of drug effects on the process of fibrogenesis in CLD, the effect of these drugs on carbohydrate metabolism are listed.

scholarly journals P-152 The impact of 2nd-line treatment after 1st-line gemcitabine plus nab-paclitaxel in advanced pancreatic cancer patients

2020 ◽  
Vol 31 ◽  
pp. S139
Author(s):  
M. Bensi ◽  
B. Di Stefano ◽  
M. Chiaravalli ◽  
M. Ribelli ◽  
A. Spring ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Advanced Pancreatic Cancer ◽  
Line Treatment ◽  
The Impact

Impact on prognosis of early weight loss during palliative chemotherapy in patients diagnosed with advanced pancreatic cancer

Pancreatology ◽  
2020 ◽  
Vol 20 (8) ◽  
pp. 1682-1688
Author(s):  
Lindsay Carnie ◽  
Marc Abraham ◽  
Mairéad G. McNamara ◽  
Richard A. Hubner ◽  
Juan W. Valle ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Weight Loss ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
Early Weight Loss

scholarly journals Neutrophil‐to‐lymphocyte ratio for predicting palliative chemotherapy outcomes in advanced pancreatic cancer patients

2014 ◽  
Vol 3 (2) ◽  
pp. 406-415 ◽  
Author(s):  
Peng Xue ◽  
Masashi Kanai ◽  
Yukiko Mori ◽  
Takafumi Nishimura ◽  
Norimitsu Uza ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio

Characterization of patients with high serum level of IL-6 in advanced pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 197-197
Author(s):  
Tomofumi Miura ◽  
Shuichi Mitsunaga ◽  
Satoshi Shimizu ◽  
Izumi Ohno ◽  
Hideaki Takahashi ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Liver Metastasis ◽  
Advanced Pancreatic Cancer ◽  
Disease Status ◽  
High Serum ◽  
Related Factor ◽  
Related Factors ◽  
Reactive Protein ◽  
Treatment Naïve

197 Background: IL-6 is a key mediator of cancer cachexia. The degree of cachexia affects serum IL-6 level in pancreatic cancer (PC) and is varied according to disease progression. The study population to characterize advanced PC patients with high IL-6 level needs the homogeneity in disease status. This study was aimed to identify IL-6-related factors in patients who were scheduled to undergo first-line chemotherapy for treatment-naïve advanced PC. Methods: Patients with treatment-naïve advanced PC were eligible for inclusion in this study. Patients with obvious infection or biliary drainage were excluded. Serum IL-6 levels and clinical parameters (e.g. symptoms, body composition) were prospectively collected. A high IL-6 level was defined as a value greater than the median value in all of the analyzed patients, and analyses were performed to identify risk factors for high IL-6 levels. Results: Eighty patients were analyzed. A multivariate analysis determined that the following parameters were associated with high IL-6: the presence of liver metastasis [Odds ratio (OR): 4.8, p < 0.01], fatigue (OR 3.4, p = 0.02), high carcinoembryonic antigen (CEA) levels (OR: 6.9, p = 0.03), anemia (OR: 9.5, p = 0.01), and high C-reactive protein (CRP) levels (OR: 12.4, p = 0.02). A decreased skeletal muscle mass tended to be frequently observed in patients with high IL-6 levels. Conclusions: High serum IL-6 related the presence of liver metastasis, severe fatigue, high CEA, high CRP and anaemia. Additionally, skeletal muscle loss might be the IL-6 related factor.

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