Obesity and survival in population-based patients with pancreatic cancer in the San Francisco Bay Area

Gong, Zhihong; Holly, Elizabeth A.; Bracci, Paige M.

doi:10.1007/s10552-012-0070-3

Cited by 21 publications

(16 citation statements)

References 41 publications

(31 reference statements)

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“…12,13,21–31 For the purposes of data abstraction, all studies were cohort by design (with subjects being followed over time after exposure [obesity], for development of outcome [mortality]), although some studies inherently were reported as case-control studies. 12,24,25 Although 5 studies 12,21,23–25 included a cohort of patients with established pancreatic cancer and reported the association between premorbid obesity and all-cause mortality, 8 studies were large cohorts of cancer-free participants at inception and followed them for development of pancreatic cancer-related mortality through record linkage with national death indices. The characteristics of the included studies are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of the included studies are shown in Table 1. Eleven studies were based in North America or Europe, 12,21–25,27–31 including 1 pooled study of 7 cohorts of black participants. 27 Two studies were conducted in the Asia-Pacific region, both pooled analysis of multiple individual cohorts (30 cohorts from the Asia-Pacific Cohort Studies Collaboration 26 and 16 cohorts from the Asia Cohort Consortium 13 ).…”

Section: Resultsmentioning

confidence: 99%

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Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis

Majumder

Gupta

Arora

et al. 2016

Clinical Gastroenterology and Hepatology

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Background & Aims Obesity is associated with an increased risk for pancreatic cancer, but it is unclear whether it affects mortality. We performed a systematic review and meta-analysis to assess the association between premorbid obesity and mortality from pancreatic cancer. Methods We performed a systematic search through January 2015 and identified studies of the association between premorbid obesity (at least 1 year prior to pancreatic cancer diagnosis) and pancreatic cancer–related mortality. We estimated summary adjusted hazard ratio (aHR) with 95% confidence interval (CI), comparing data from obese (body mass index [BMI] ≥30 kg/m2) and overweight subjects (BMI, 25.0–29.9 kg/m2) with those from individuals with a normal BMI (controls) by using random-effects model. Results We identified 13 studies (including 3 studies that pooled multiple cohorts); 5 studies included only patients with pancreatic cancer, whereas 8 studies evaluated pancreatic cancer–related mortality in cancer-free individuals at inception. In the meta-analysis, we observed increase in pancreatic cancer–related mortality among overweight (aHR, 1.06; 95% CI, 1.02–1.11; I2 = 0) and obese individuals (aHR, 1.31; 95% CI, 1.20–1.42; I2 = 43%), compared with controls; the association remained when we analyzed data from only subjects with pancreatic cancer. Each 1 kg/m2 increase in BMI was associated with 10% increase in mortality (aHR, 1.10; 95% CI, 1.05– 1.15) with minimal heterogeneity (I2 = 0). In the subgroup analysis, obesity was associated with increased mortality in Western populations (11 studies; aHR, 1.32; 95% CI, 1.22–1.42) but not in Asia-Pacific populations (2 studies; aHR, 0.98; 95% CI, 0.76–1.27). Conclusions In a systematic review and meta-analysis, we associated increasing level of obesity with increased mortality in patients with pancreatic cancer in Western but not Asia-Pacific populations. Strategies to reduce obesity-induced metabolic abnormalities might be developed to treat patients with pancreatic cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis

Majumder

Gupta

Arora

et al. 2016

Clinical Gastroenterology and Hepatology

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“…In a previously conducted population-based study of PC in the San Francisco Bay Area, a significant proportion of patients died prior to study contact. 3,43,44 In the current study, recruitment of patients in the clinic helped minimize the potential for survival bias. Detailed information on potential confounding variables was gathered using validated questionnaires.…”

Section: Discussionmentioning

confidence: 99%

“…2 With active follow up of patients this rate drops to 2%. 3 This poor prognosis is partly attributable to metastatic disease at diagnosis. Even though genomic evidence suggests that PC cells take at least 5 years to develop metastatic capability, 4 more than 80% of patients have advanced and/or metastatic disease at the time of disease presentation, 5 at which point potentially curative surgery is not an option.…”

Section: Introductionmentioning

confidence: 99%

Metformin use among type 2 diabetics and risk of pancreatic cancer in a clinic‐based case–control study

Walker

Holly

et al. 2014

Intl Journal of Cancer

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A better understanding of the association between diabetes and pancreatic cancer (PC) may inform prevention and/or early detection strategies. Metformin has been associated with reduced risk of certain cancers, including PC, in some observational clinical studies. We assessed whether metformin use was associated with PC risk among those with type 2 diabetes (DM2), and whether metformin use modulated the association between DM2 and risk of PC. In total, 536 PC cases and 869 frequencymatched controls were recruited predominantly from University of California San Francisco medical clinics from 2006 to 2011. Eligible participants completed direct interviews using a structured risk factor questionnaire. The association between metformin use and PC risk was assessed using propensity score-weighted unconditional logistic regression methods in analyses restricted to diabetics and adjusted multivariable logistic models in the total study population. Ever use of metformin was not associated with PC risk in analyses restricted to DM2 (N 5 170) participants (adjusted OR: 1.01, 95% CI: 0.61-1.68). In the total study population (N 5 1,405) using nondiabetics as the referent group, PC risk was inversely associated with diabetes duration (p trend < 0.001). Further, when DM2 participants were grouped by ever/never use of metformin and compared with nondiabetics, metformin use did not affect the association between DM2 and PC risk (never users: OR: 1.44, 95% CI: 0.78-2.67; ever users: OR: 1.19, 95% CI: 0.72-1.99). Results from our clinic-based case-control study suggest that metformin use is not associated with PC risk among those with DM2 and does not alter the association between DM2 and PC risk.Pancreatic cancer (PC) is diagnosed in 45,000 U.S. adults each year, making it the ninth most common cancer in women and the tenth most common in men. 1 However, given its dismal prognosis, PC is the fourth most common cause of cancer-related mortality in both sexes, with the lowest 5-year survival rate of all major cancers at 6%. 2 With active follow-up of patients this rate drops to 2%. 3 This poor prognosis is partly attributable to metastatic disease at diagnosis. Even though genomic evidence suggests that PC cells take at least 5 years to develop metastatic capability, 4 more than 80% of patients have advanced and/or metastatic disease at the time of disease presentation, 5 at which point potentially curative surgery is not an option. To date, no population-wide screening tool reduces mortality associated with this disease. Identifying risk factors and protective factors may help in the development of screening programs targeted toward individuals at particularly high risk, inform appropriate recommendations regarding modifiable lifestyle habits and aid in PC prevention strategies.PC is more common in men than women, among blacks/ African Americans compared with whites and increases with age. 2

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“…In an earlier population-based casecontrol study of PC in the San Francisco Bay Area(SFBA), the 5-year survival rate was 1.5%, with a 10-month median survival time using active follow-up methods [5,6].…”

Section: Introductionmentioning

confidence: 99%

Cigarette smoking and risk of pancreatic cancer: a clinic-based case-control study in the San Francisco Bay Area

Lea

Holly

Bracci

2015

Annals of Epidemiology

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Obesity and survival in population-based patients with pancreatic cancer in the San Francisco Bay Area

Cited by 21 publications

References 41 publications

Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis

Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis

Metformin use among type 2 diabetics and risk of pancreatic cancer in a clinic‐based case–control study

Cigarette smoking and risk of pancreatic cancer: a clinic-based case-control study in the San Francisco Bay Area

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