Farias Albert J, Wu Anna H, Porcel Jacqueline, Marchand Loïc Le, Wilkens Lynne R, Monroe Kristine R, Maskarinec Gertraud, Pandol Stephen J, Setiawan Veronica Wendy
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
JNCI Cancer Spectr. 2020 May 4;4(5):pkaa035. doi: 10.1093/jncics/pkaa035. eCollection 2020 Oct.
People with diabetes are at an increased risk of developing pancreatic cancer. However, it is unclear whether diabetes-related complications are associated with risk of pancreatic cancer.
A nested matched case-control analysis was conducted among the fee-for-service Medicare participants of the prospective Multiethnic Cohort (n = ∼123 000). Between 2001 and 2014, 433 incident cases of pancreatic ductal adenocarcinoma were matched to 1728 controls by birth year, sex, race and ethnicity, and age at cohort entry. Participants were linked to data from the California and Hawaii cancer registries and Medicare claims. We used the diabetes complications severity index (DCSI) for the presence of 7 complications within 2 years prior to the diagnosis date of the index case. Multivariable conditional logistic regression was used to examine the association of DCSI with pancreatic cancer incidence.
Diabetes was present among 45.4% of cases and 34.1% of controls. Cases had higher DCSI score compared with controls (score ≥4: 32.8% in cases; 21.2% in controls). The most prevalent diabetes-related complications for cases were cardiovascular disease (61.2%), nephropathy (31.2%), and cerebrovascular disease (21.7%). Individuals with diabetes (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.14 to 1.91), nephropathy (OR = 1.75, 95% CI = 1.32 to 2.33), cardiovascular disease (OR = 1.88, 95% CI = 1.45 to 2.44), and metabolic complications (OR = 6.61, 95% CI = 2.49 to 17.50) were at increased risk of pancreatic cancer. For every 1-unit increase in DCSI score, participants had 18% greater risk of pancreatic cancer (OR = 1.18, 95% CI = 1.11 to 1.25).
Participants with diabetes-related complications have an elevated risk of pancreatic cancer. Identifying diabetes-related complications may help identify high-risk groups who can be studied for development of early markers for this fatal cancer.
糖尿病患者患胰腺癌的风险增加。然而，尚不清楚糖尿病相关并发症是否与胰腺癌风险相关。
在多民族前瞻性队列研究的按服务收费的医疗保险参与者中进行了一项巢式匹配病例对照分析（n = 约123,000）。2001年至2014年期间，433例胰腺导管腺癌新发病例按出生年份、性别、种族和族裔以及队列进入时的年龄与1728例对照进行匹配。参与者与加利福尼亚州和夏威夷州癌症登记处的数据以及医疗保险理赔数据相关联。我们使用糖尿病并发症严重程度指数（DCSI）来评估在索引病例诊断日期前2年内是否存在7种并发症。采用多变量条件逻辑回归分析来检验DCSI与胰腺癌发病率之间的关联。
45.4%的病例和34.1%的对照患有糖尿病。病例的DCSI评分高于对照（评分≥4：病例中为32.8%；对照中为21.2%）。病例中最常见的糖尿病相关并发症是心血管疾病（61.2%）、肾病（31.2%）和脑血管疾病（21.7%）。患有糖尿病（比值比[OR]=1.48，95%置信区间[CI]=1.14至1.91）、肾病（OR = 1.75，95% CI = 1.32至2.33）、心血管疾病（OR = 1.88，95% CI = 1.45至2.44）和代谢并发症（OR = 6.61，95% CI = 2.49至17.50）的个体患胰腺癌的风险增加。DCSI评分每增加1个单位，参与者患胰腺癌的风险增加18%（OR = 1.18，95% CI = 1.11至1.25）。
患有糖尿病相关并发症的参与者患胰腺癌的风险升高。识别糖尿病相关并发症可能有助于识别高危人群，这些人群可用于研究这种致命癌症的早期标志物的开发。
