Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St., 3rd floor, New Orleans, LA, 70112, USA.
Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA.
Cancer Causes Control. 2022 Jan;33(1):37-48. doi: 10.1007/s10552-021-01497-z. Epub 2021 Oct 11.
Our study aimed to examine the impact of diabetes, smoking and BMI on pancreatic cancer survival in a population-based setting by adjusting both sociodemographic and clinical factors and measuring their attributable risk.
Data on pancreatic adenocarcinoma patients diagnosed in 2011-2017 were acquired from the Louisiana Tumor Registry. Diabetes, smoking, height, and weight were abstracted from medical records and linked with Hospital Inpatient Discharge Data to enhance the completeness of the diabetes data. The Cox regression model was used to assess effect sizes of diabetes, smoking, and BMI on cancer-specific survival and survival rate. The partial population attributable risk was employed to measure the attributable risk of these risk factors.
Of the 3,200 eligible patients, 34.6% were diabetics, 23.9% were current smokers, and 52.3% had BMI ≥ 25 kg/m. After adjusting for sociodemographic and clinical factors, diabetic patients had an increased cancer-specific death risk of 15% (95% CI, 1.06-1.25), 36% (95% CI, 1.19-1.44) for current smokers, and 24% (95% CI, 1.00-1.54) for patients with a BMI ≥ 40 when compared to their counterparts. Diabetic current smokers had significantly lower 2- and 3-year adjusted cancer-specific survival rates, 13.1% and 10.5%, respectively. By eliminating diabetes and modifiable risk factors, an estimated 16.6% (95% CI, 6.9%-25.9%) of the cancer-specific deaths could be avoided during a nine-year observational period between 2011 and 2019.
Diabetes and smoking contributed substantially to the reduction of pancreatic cancer survival even after controlling for sociodemographic and clinical factors; however, BMI ≥ 35 was observed to increase risk of mortality among stage III-IV patients only.
本研究旨在通过调整社会人口统计学和临床因素，并测量其归因风险，在基于人群的环境中检查糖尿病、吸烟和 BMI 对胰腺癌生存的影响。
从路易斯安那肿瘤登记处获取 2011 年至 2017 年间诊断为胰腺腺癌患者的数据。从病历中提取糖尿病、吸烟、身高和体重，并与住院患者出院数据相关联，以提高糖尿病数据的完整性。使用 Cox 回归模型评估糖尿病、吸烟和 BMI 对癌症特异性生存和生存率的影响大小。部分人群归因风险用于测量这些危险因素的归因风险。
在 3200 名合格患者中，34.6%患有糖尿病，23.9%为当前吸烟者，52.3%的 BMI≥25kg/m。在调整社会人口统计学和临床因素后，与对照组相比，糖尿病患者的癌症特异性死亡风险增加了 15%（95%CI，1.06-1.25），当前吸烟者的癌症特异性死亡风险增加了 36%（95%CI，1.19-1.44），BMI≥40 的患者的癌症特异性死亡风险增加了 24%（95%CI，1.00-1.54）。与糖尿病相关的当前吸烟者的 2 年和 3 年调整癌症特异性生存率明显较低，分别为 13.1%和 10.5%。通过消除糖尿病和可改变的危险因素，估计在 2011 年至 2019 年的九年观察期间，可以避免 16.6%（95%CI，6.9%-25.9%）的癌症特异性死亡。
即使在控制了社会人口统计学和临床因素后，糖尿病和吸烟仍然对降低胰腺癌生存有很大贡献；然而，仅观察到 BMI≥35 会增加 III 期和 IV 期患者的死亡风险。
