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
| Patients | All | OS (95%CI) months | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N | ≤8 mmol/L | N | >8 mmol/L | P value | N | <14 mmol/L | N | ≥14 mmol/L | P value | ||
| Stage 1-4 | 640 | 360 | 9.7 (8.3-11.3) | 232 | 7.1 (5.7-8.3) | 0.002 | 515 | 8.5 (7.8-10.1) | 77 | 7.1 (5.1-9.0) | 0.001 |
| Palliative | 519 | 274 | 7.6 (6.7-8.3) | 201 | 6.2 (5.1-7.1) | 0.5 | 408 | 7.1 (6.2-7.8) | 67 | 5.5 (4.6-8.3) | 0.23 |
| Curative | 115 | 83 | 27.4 (21.8-34.0) | 29 | 18.9 (14.0-NA) | 0.25 | 103 | 27.8 (21.8-45.8) | 9 | 12.9 (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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