Poor Glycemic Control Is Associated with Failure to Complete Neoadjuvant Therapy and Surgery in Patients with Localized Pancreatic Cancer. J Gastrointest Surg 2017 Mar;21(3):496-505
Date
11/30/2016Pubmed ID
27896658DOI
10.1007/s11605-016-3319-4Scopus ID
2-s2.0-84997795492 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
BACKGROUND: The impact of glycemic control in patients with pancreatic cancer treated with neoadjuvant therapy is unclear.
METHODS: Glycated hemoglobin (HbA1c) values were measured in patients with localized pancreatic cancer prior to any therapy (pretreatment) and after neoadjuvant therapy prior to surgery (preoperative). HbA1c levels greater than 6.5% were classified as abnormal. Patients were categorized based on the change in HbA1c levels from pretreatment to preoperative: GrpA, always normal; Gr B, worsened; GrpC, improved; and GrpD, always abnormal.
RESULTS: Pretreatment HbA1c levels were evaluable in 123 patients; there were 67 (55%) patients in GrpA, 8 (6%) in GrpB, 22 (18%) in GrpC, and 26 (21%) in GrpD. Of the 123 patients, 92 (75%) completed all intended therapy to include surgery; 57 (85%) patients in GrpA, 4 (50%) patients in GrpB, 16 (72%) patients in GrpC, and 15 (58%) patients in GrpD (p = 0.01). Elevated preoperative carbohydrate antigen 19-9 (CA19-9) (OR 0.22;[0.07-0.66]), borderline resectable (BLR) disease stage (OR 0.20;[0.01-0.45]) and abnormal preoperative HbA1c (OR 0.30;[0.11-0.90]) were negatively associated with completion of all intended therapy. Abnormal preoperative HbA1c was associated with a 2.74-fold increased odds of metastatic progression during neoadjuvant therapy (p = 0.08).
CONCLUSIONS: Elevated preoperative HbA1c is associated with failure to complete neoadjuvant therapy and surgery and a trend for increased risk of metastatic progression.
Author List
Rajamanickam ES, Christians KK, Aldakkak M, Krepline AN, Ritch PS, George B, Erickson BA, Foley WD, Aburajab M, Evans DB, Tsai SAuthors
Kathleen K. Christians MD Professor in the Surgery department at Medical College of WisconsinBeth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
CA-19-9 Antigen
Chemoradiotherapy, Adjuvant
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Metastasis
Pancreatectomy
Pancreatic Neoplasms
Treatment Outcome
