Poor Glycemic Control Is Associated with Failure to Complete Neoadjuvant Therapy and Surgery in Patients with Localized Pancreatic Cancer

E. S Paul Rajamanickam, K. K. Christians, M. Aldakkak, A. N. Krepline, P. S. Ritch, B. George, B. A. Erickson, W. D. Foley, M. Aburajab, D. B. Evans, S. Tsai

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Nov 28 2016
Externally publishedYes

Keywords

  • Diabetes
  • Neoadjuvant therapy
  • Pancreatic cancer

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Rajamanickam, E. S. P., Christians, K. K., Aldakkak, M., Krepline, A. N., Ritch, P. S., George, B., Erickson, B. A., Foley, W. D., Aburajab, M., Evans, D. B., & Tsai, S. (Accepted/In press). Poor Glycemic Control Is Associated with Failure to Complete Neoadjuvant Therapy and Surgery in Patients with Localized Pancreatic Cancer. Journal of Gastrointestinal Surgery, 1-10. https://doi.org/10.1007/s11605-016-3319-4