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Elevated Hemoglobin A1c Levels Are Associated with Worse Survival in Advanced Pancreatic Cancer Patients with Diabetes

이윤석|이태윤|구자경|심찬섭|천영국
거트앤리버 소화기연관학회협의회|2014.03|Gut and Liver|제8권 제2호|pp. 205-214

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키워드

Diabetes mellitusMetforminPancreatic neoplasmsGlycosylated hemoglobin A

초록

Background/Aims: Pre-existing diabetes mellitus (DM) hasbeen identified as an adverse prognostic variable associatedwith increased mortality in various cancers. Although DM andhyperglycemia are considered risk factors for pancreatic cancer(PC), antidiabetic treatments for patients with advancedPC have been overlooked. This study aimed to evaluate theimpact of hemoglobin A1c (HbA1c) levels on PC survival. Methods: We retrospectively reviewed the medical records offirst-diagnosed patients with advanced PC who were admittedto Konkuk University Medical Center from 2005 to 2011. Results: A total of 127 patients were enrolled, and therewere 111 deaths (87.4%) within the 7-year observationalperiod. The most common etiology was disease progression(n=108). DM before PC diagnosis was observed in 65 patients(51.1%), including 28 patients with new-onset DM. Theoverall median survival times in patients with and withoutDM were 198 and 263 days, respectively (p=0.091). Survivaltime according to HbA1c was significantly different betweenthe <7.0% and ≥7.0% groups (362 and 144 days, respectively;p=0.038). In the HbA1c ≥7.0% group, the median overallsurvival time was 273 days for the metformin group and145 days for the nonmetformin oral agent group; however,there was no significant difference between the two groups(p=0.058). Conclusions: A high HbA1c level may be associatedwith worse survival in patients with advanced PC withDM. Antidiabetic treatment, metformin in particular, was associatedwith an improved outcome.

Abstract

Background/Aims: Pre-existing diabetes mellitus (DM) hasbeen identified as an adverse prognostic variable associatedwith increased mortality in various cancers. Although DM andhyperglycemia are considered risk factors for pancreatic cancer(PC), antidiabetic treatments for patients with advancedPC have been overlooked. This study aimed to evaluate theimpact of hemoglobin A1c (HbA1c) levels on PC survival. Methods: We retrospectively reviewed the medical records offirst-diagnosed patients with advanced PC who were admittedto Konkuk University Medical Center from 2005 to 2011. Results: A total of 127 patients were enrolled, and therewere 111 deaths (87.4%) within the 7-year observationalperiod. The most common etiology was disease progression(n=108). DM before PC diagnosis was observed in 65 patients(51.1%), including 28 patients with new-onset DM. Theoverall median survival times in patients with and withoutDM were 198 and 263 days, respectively (p=0.091). Survivaltime according to HbA1c was significantly different betweenthe <7.0% and ≥7.0% groups (362 and 144 days, respectively;p=0.038). In the HbA1c ≥7.0% group, the median overallsurvival time was 273 days for the metformin group and145 days for the nonmetformin oral agent group; however,there was no significant difference between the two groups(p=0.058). Conclusions: A high HbA1c level may be associatedwith worse survival in patients with advanced PC withDM. Antidiabetic treatment, metformin in particular, was associatedwith an improved outcome.

참고문헌 (36)

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