Are risk factors associated with outcomes in pancreatic cancer?

Abstract

Background: The development of pancreatic cancer is a process in which genes interact with environmental factors. We performed this study to determine the effects of the ABO blood group, obesity, diabetes mellitus, metabolic syndrome (MetS), smoking, alcohol consumption and hepatitis B viral (HBV) infection on patient survival.

Methods: A total of 488 patients with pancreatic cancer were evaluated.

Result: Patients who presented as chronic carriers of HBV infection were younger at disease onset (p = 0.001) and more predominantly male (p = 0.020) than those never exposed to HBV. Patients with MetS had later disease staging (p = 0.000) and a lower degree of pathological differentiation (p = 0.008) than those without MetS. In a univariate analysis, the ABO blood group, smoking and alcohol consumption were not associated with overall survival. HBsAg-positivity and elevated fasting plasma glucose were significantly associated with unfavorable survival though not in the multivariate analysis. The presence of MetS (HR: 1.541, 95% CI: 1.095-2.169, p = 0.013), age ≥65, an elevated CA19-9 baseline level, TNM staging, the type of surgery, the degree of differentiation and chemotherapy were independently associated with overall survival.

Conclusion: We report, for the first time, that patients with chronic HBV infection may represent a special subtype of pancreatic cancer, who have a younger age of disease onset and male dominancy. Patients with MetS had later disease staging and a poorer histological grade. Patients with MetS demonstrated significantly poorer survival.

Figure 1. The overall survival comparing patients with metabolic syndrome (MetS) and those without in a univariate analysis.

Figure 2. (A) The median age according to hepatitis B viral (HBV) infection status in patients with pancreatic cancer.

The boxes represent values between the 25th and 75th percentiles, and the horizontal lines within the boxes indicate the median value. The median age (±standard deviation) of patients with HBsAg-positivity/anti-HBc-positivity was 52.00±11.155 years old, and for those with HBsAg-negativity/anti-HBc-negativity, it was 60.50±10.747 years old (p = 0.001). (B) The association between the presence of metabolic syndrome (MetS) and tumor-node-metastasis (TNM) staging in patients with pancreatic cancer. A total of 66 (90.41%) patients presenting with MetS were stage III or IV compared with 279 (67.23%) patients who did not have MetS (p = 0.000). (C) The association between the presence of metabolic syndrome (MetS) and the degree of histological differentiation in patients with pancreatic cancer. Dedifferentiated histology was more frequent in patients with than without MetS. A total of 38 (73.10%) patients presenting with MetS were poorly differentiated or had mucinous adenocarcinoma compared with 147 (49.80%) patients without MetS (p = 0.008).