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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

3224 - Effects of random glucose (Glc) levels on outcomes of patients (pts) with pancreatic ductal adenocarcinoma (PDAC)

Date

21 Oct 2018

Session

Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

Topics

Translational Research

Tumour Site

Pancreatic Cancer

Presenters

Rille Pihlak

Citation

Annals of Oncology (2018) 29 (suppl_8): viii205-viii270. 10.1093/annonc/mdy282

Authors

R. Pihlak1, R. Almond2, P. Srivastava3, H. Raja3, R. Broadbent4, L. Hopewell5, C. Higham5, A. Lamarca4, R. Hubner4, J.W. Valle1, M.G. McNamara1

Author affiliations

  • 1 Medical Oncology/division Of Cancer Sciences, The Christie NHS Foundation Trust/University of Manchester, M20 4BX - Manchester/GB
  • 2 Analytics And Development, Clinical Outcome Unit, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 3 Faculty Of Biology, Medicine And Health, University Manchester, M113N7 - Manchester/GB
  • 4 Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 5 Endocrinology Department, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
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Resources

Abstract 3224

Background

Pancreatic ductal adenocarcinoma is a dismal disease with poor outcomes; ∼85% of pts with PDAC have impaired Glc tolerance or diabetes. This study explored how random Glc levels influence pt outcomes.

Methods

Consecutive pts with PDAC (all stages) (Jan 12-Jul 17) were included; 3 blood Glc level thresholds were referenced: >8 mmol/L (requiring monitoring), ≥14 mmol/L (requiring antidiabetic treatment), >11mmol/L on 2 occasions (fulfilling WHO diabetes criteria). Survival outcomes/prognostic factors were analysed by log-rank, Kaplan Meier and multivariable Cox regression.

Results

Of 640 pts: 53 % were male, median (med) age 68y, 64% ECOG PS 0/1, 22% PS 2, 14% PS 3/4; 26% stage 1/2 disease, 74% stage 3/4; 81% treated with palliative intent (chemotherapy in 325) and 15% adjuvant; 29% pts had a previous diabetes diagnosis. Med baseline Glc: 7.3mmol/L (range 3.8-37.1); 377 (59%) and 145 (23%) pts had Glc >8mmol/L and ≥14 mmol/L respectively, either at baseline or during treatment, 124 (19%) had Glc >11mmol/L on 2 occasions (of whom 81 were known diabetic). Med PFS and OS for all stages were 6.7 (95%CI 6.0-7.1) and 8.1 (95%CI 7.4-8.8) months (mo) respectively. Med OS for stage 1/2: 11.3 mo (95%CI 9.4-13.8), stage 3/4 disease 5.3 mo (95%CI 4.8-6). Previous diabetes diagnosis and antidiabetic treatment did not significantly impact OS (P = 0.26, P = 0.5 respectively). Baseline Glc levels (>8mmol/L and ≥14 mmol/L; Table), but not hyperglycaemia during treatment, significantly affected OS in all pts. Multivariable analysis (once adjusted for age and primary site) found increasing stage (P < 0.001), high minimum Glc (ever)(P < 0.001), high CA19-9 (P < 0.001), worse ECOG PS (P < 0.01) , and low albumin (P = 0.02) were prognostic for worse OS.Table: 751P

PatientsAllOS (95%CI) months
N≤8 mmol/LN>8 mmol/LP valueN<14 mmol/LN≥14 mmol/LP value
Stage 1-46403609.7 (8.3-11.3)2327.1 (5.7-8.3)0.0025158.5 (7.8-10.1)777.1 (5.1-9.0)0.001
Palliative5192747.6 (6.7-8.3)2016.2 (5.1-7.1)0.54087.1 (6.2-7.8)675.5 (4.6-8.3)0.23
Curative1158327.4 (21.8-34.0)2918.9 (14.0-NA)0.2510327.8 (21.8-45.8)912.9 (9.2-NA)<0.0001

Conclusions

This study demonstrated for the first time that baseline Glc above thresholds and the absolute minimum random Glc confers worse outcomes, irrespective of previous diabetes diagnosis. Whether this risk is modifiable is subject to further research.

Clinical trial identification

Legal entity responsible for the study

The Christie NHS Foundation Trust.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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