The role of risk factors on survival for patients with pancreatic cancer

Abstract

Background: Previous epidemiological studies have shown that diabetes mellitus (DM), alcohol, smoking and pancreatic cancer (PC) in close relatives are risk factors for developing PC. We investigated if these known risk factors are associated with short overall survival (OS) in patients with PC. Methods: 629 patients with pancreatic ductal adenocarcinoma (PDAC) (M/F 346/283, stage I (n = 22), stage II (n = 183), stage III (90) and stage IV (n = 334)) and 53 patients with ampullary adenocarcinoma (AAC) (M/F 32/20, stage I (n = 11), stage II (n = 26), stage III (13) and stage IV (n = 3)) were included from 6 hospitals in the Danish BIOPAC project from July 2008 to April 2016. Baseline clinical characteristics, IDDM, NIDDM, patient's history of cancer or family history of cancer were retrospectively registered and analyzed. Hazard ratios (HR) were estimated for OS by means of Cox proportional hazards model. Results: 117 (19%) of the PDAC and 5 (11%) of the AAC patients had known IDDM or NIDDM at time of diagnosis. 471 (69%) had family history of cancer; most common types were breast cancer (7%), colorectal cancer (6.7%), lung cancer (6.7%), PC (6%) and uterus (3.4%). 36.7% were former smokers and 30% were current smokers. 25% had previous or present high alcohol intake. Known IDDM and NIDDM at time of diagnosis were associated with short OS (HR = 1.52, 95% CI 1.11-2.07, p = 0.01 and HR = 1.36, 95% CI 1.00-1.83, p = 0.05, respectively). Present or previous high alcohol intake, tobacco use, family history of cancer or own earlier cancer or gastrointestinal inflammation were not associated with poor prognosis. Conclusions: In this Danish multicenter study we demonstrated that known IDDM and NIDDM at time of diagnosis were the only risk factors associated with poor prognosis.