Are There Signs or Symptoms That Predate the Diagnosis of Pancreatic Cancer?

Are There Signs or Symptoms That Predate the Diagnosis of Pancreatic Cancer?

Vanessa M. Shami, MD, FASGE, reviewing Brewer MJ, et al. Clin Gastroenterol Hepatol 2021 Aug 3.

Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer mortality since most cancers are advanced at diagnosis. Early identification of these cancers is essential. This case-control study aimed to describe glycemic and weight changes that occur before PDAC diagnosis in a diverse population. 

Cases of PDAC at a tertiary care institution between January 2011 and November 2019 were matched with controls in a 1:2 fashion (1542 cases:3084 controls). The median age was 69.3 years, 2487 patients (53.8%) were male, and 751 (48.7%) were non-Hispanic White. Study periods were 54 to 66 months, 42 to 54 months, 30 to 42 months, 18 to 30 months, 6 to 18 months, and 0 to 6 months before PDAC diagnosis. Comparison of cases and controls at each study interval was performed using t tests for normally distributed variables and the Wilcoxon rank sum test for variables not normally distributed. Logistic regression was used to estimate odds of PDAC based on changes over time in hemoglobin A1c (HbA1c) and body mass index (BMI), controlling for appropriate confounders. 

HbA1c was higher in PDAC cases than controls (P≤.02 for all) in the 3 years before diagnosis. For all study periods, BMI was greater for PDAC cases, except 0 to 6 months before cancer diagnosis when BMI was lower (P<.01 for all). The BMI change in cases 1 year and 6 months before diagnosis was -0.59 and -1.21 (P<.01) when compared with -0.08 and 0.03 for controls (P<.01), respectively. After adjusting for race, smoking, alcohol use, sex, and age, multivariate logistic regression demonstrated that HbA1c slope (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.01-1.76) and BMI slope (aOR, 0.75; 95% CI, 0.65-0.87) were predictors of PDAC.

Vanessa M. Shami, MD, FASGE

COMMENT

Further prospective trials are needed to understand the relationship between diabetes, weight/BMI, and PDAC to better predict patients at high risk for developing the disease. Whether these variables can be used in the future to screen for PDAC in high-risk patients remains to be seen. The ultimate goal is to detect cancers at an earlier stage and improve prognosis.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Brewer MJ, Doucette JT, Bar-Mashiah A, et al. Glycemic changes and weight loss precede pancreatic ductal adenocarcinoma by up to 3 years in a diverse population. Clin Gastroenterol Hepatol 2021 Aug 3. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2021.07.046)

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