Poor Glycemic Control Is Associated with Failure to Complete Neoadjuvant Therapy and Surgery in Patients with Localized Pancreatic Cancer

• Published in: Journal of gastrointestinal surgery Vol. 21; no. 3; pp. 496 - 505
• Main Authors: Rajamanickam, E. S. Paul, Christians, K. K., Aldakkak, M., Krepline, A. N., Ritch, P. S., George, B., Erickson, B. A., Foley, W. D., Aburajab, M., Evans, D. B., Tsai, S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2017; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; CA-19-9 Antigen - blood; Chemoradiotherapy, Adjuvant; Female; Gastroenterology; Glycated Hemoglobin - metabolism; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Metastasis; Original Article; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - therapy; Surgery; Treatment Outcome; Neoadjuvant therapy; Pancreatic cancer; Diabetes
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-016-3319-4

Background The impact of glycemic control in patients with pancreatic cancer treated with neoadjuvant therapy is unclear. Methods Glycated hemoglobin (HbA1c) values were measured in patients with localized pancreatic cancer prior to any therapy (pretreatment) and after neoadjuvant therapy prior to surgery (preoperative). HbA1c levels greater than 6.5% were classified as abnormal. Patients were categorized based on the change in HbA1c levels from pretreatment to preoperative: GrpA, always normal; Gr B, worsened; GrpC, improved; and GrpD, always abnormal. Results Pretreatment HbA1c levels were evaluable in 123 patients; there were 67 (55%) patients in GrpA, 8 (6%) in GrpB, 22 (18%) in GrpC, and 26 (21%) in GrpD. Of the 123 patients, 92 (75%) completed all intended therapy to include surgery; 57 (85%) patients in GrpA, 4 (50%) patients in GrpB, 16 (72%) patients in GrpC, and 15 (58%) patients in GrpD ( p  = 0.01). Elevated preoperative carbohydrate antigen 19-9 (CA19-9) (OR 0.22;[0.07–0.66]), borderline resectable (BLR) disease stage (OR 0.20;[0.01–0.45]) and abnormal preoperative HbA1c (OR 0.30;[0.11–0.90]) were negatively associated with completion of all intended therapy. Abnormal preoperative HbA1c was associated with a 2.74-fold increased odds of metastatic progression during neoadjuvant therapy ( p  = 0.08). Conclusions Elevated preoperative HbA1c is associated with failure to complete neoadjuvant therapy and surgery and a trend for increased risk of metastatic progression.