Are risk factors associated with outcomes in pancreatic cancer?

Risk factors for early-onset pancreatic ductal adenocarcinoma: A systematic literature review

BACKGROUND

Emerging cancer trends suggest an increase in pancreatic cancer incidence in individuals younger than its typical age of onset, potentially reflecting changes in population exposures and lifestyles.

PATIENTS AND METHODS

We conducted a PRISMA-standard systematic literature review to identify non-heritable risk factors for early-onset pancreatic ductal adenocarcinoma (PDAC) (PROSPERO number: CRD42022299397). Systematic searches of MEDLINE and Embase bibliographic databases were performed (January 2022), and publications were screened against predetermined eligibility criteria; data were extracted using standardised data fields. The STROBE checklist was used to assess the completeness of reporting as a proxy for publication quality. Data were categorised by risk factor and analysed descriptively.

RESULTS

In total, 24 publications were included. All publications reported observational study data; thresholds for age group comparisons ranged between 40 and 65 years. Lifestyle factors investigated included smoking, alcohol consumption, obesity, physical inactivity, meat intake, socioeconomic status and geographical residence. Clinical factors investigated included pancreatitis, diabetes/insulin resistance, prior cancer and cancer stage at diagnosis, hepatitis B infection, metabolic syndrome and long-term proton pump inhibitor exposure. Publication STROBE scores were 6-21 (maximum, 22). Eight studies reported results adjusted for confounders. Potential non-heritable risk factors for early-onset PDAC that warrant further investigation included smoking, alcohol consumption, pancreatitis and hepatitis B infection.

CONCLUSION

Evidence for non-heritable risk factors for early-onset PDAC is heterogeneous, but four factors were identified that might aid the identification of at-risk individuals who may benefit from screening and risk reduction strategies.

A systematic review of prognosis of ABO blood group and rhesus factor on outcomes in patients with bladder cancer

BACKGROUND

Bladder cancer (BC) is the 10th most common malignancy worldwide, and some studies reported that ABO blood type or/and rhesus factor has been identified as a prognostic oncologic marker for patients with BC. We carried out a systematic review to assess the prognosis of ABO blood group and rhesus factor on outcomes in patients with bladder cancer.

METHODS

We searched databases through February 2022 for studies assessing blood group on outcomes in patients with bladder cancer.

RESULTS

We included ten studies with 15,204 participants. We found that blood type A is relevant to non-muscle-invasive BC patients treated with transurethral resection of bladder tumor and blood type B patients have a lower incidence of disease recurrence and progression. Blood type O and non-O blood type have not been found to be related to disease recurrence. However, in multivariable analyses, blood type O and non-O blood type are associated with cancer-specific mortality (CSM). Other than that, blood type B doesn't have statistical significance for BC patients accepted radical cystectomy (RC). The same results showed in blood type AB non-muscle-invasive bladder cancer patients treated with RC.

CONCLUSIONS

Our study confirmed that a particular association of blood type for prognosis of patients with BC, and ABO blood group antigen expression can be suitable biomarkers for BC. We also found that rhesus factor has no impact on prognosis of BC patients.

The prognostic impact of ABO blood type in pancreatic cancer: Relevance to adjuvant chemotherapy

BACKGROUND/PURPOSE

The aim of this study was to investigate the prognostic impact of ABO blood type in resected pancreatic cancer (PC), with a focus on adjuvant chemotherapy.

METHODS

We retrospectively analyzed 510 patients who underwent pancreatectomy for PC between 2006 and 2017. Survival outcomes were investigated according to blood type and adjuvant chemotherapy regimen (S-1, gemcitabine, or no adjuvant chemotherapy).

RESULTS

Among the 510 patients, the overall survival (OS) of patients with blood type O was significantly better compared to those with blood type non-O (5-year OS rate, 46.6% vs 30.5%, P = .025). In 241 patients treated with adjuvant S-1, the 5-year OS of patients with blood type O was significantly better than those with blood type non-O (70.7% vs 44.2%, P = .001). Multivariate analysis showed that blood type non-O was an independent prognostic factor for OS in the overall cohort (hazard ratio [HR]: 1.58, P = .002) and in patients treated with adjuvant S-1 (HR: 2.99, P < .001). In patients treated with adjuvant gemcitabine or no adjuvant chemotherapy, there was no significant difference in OS between patients with blood type O and those with blood type non-O.

CONCLUSIONS

Blood type O predicted favorable survival in patients with resected PC, which was associated with adjuvant S-1.

The Value of ABO Blood Group and Complete Blood Count for the Prognosis Analysis of Gastric Cancer Patients

OBJECTIVE

To investigate the value of ABO blood group and complete blood count results in predicting the survival rate of patients with gastric cancer.

PATIENTS AND METHODS

A retrospective study was conducted to collect 488 gastric cancer patients diagnosed in the Tumor Hospital Affiliated to Xinjiang Medical University from January 2010 to December 2011. Relevant clinical data were collected by the medical record system, and the patients were followed up by the medical record follow-up system of the hospital. The follow-up was ended until the death of the patients, and the survival time of all patients was obtained. Survival curve and Cox regression analysis model were used to study the role of various indicators in the prognosis of gastric cancer patients.

RESULTS

Neutrophil lymphocyte ratio (NLR), neutrophil monocyte ratio (NMR), lymphocyte monocyte ratio (LMR) and platelet distribution width (PDW) in blood routine test could predict the death outcome of gastric cancer patients, with the predicted thresholds of 1.95, 13.49, 5.22 and 11.25, respectively. Survival curve analysis showed that female patients, type O blood patients, LMR >5.22 patients, NMR >13.49 patients and NLR ≤1.95 patients had longer survival. Multivariate Cox regression analysis model showed that gender and NLR were independent prognosis risk factors for gastric cancer, with HR values of 2.964 (95% CI of 2.258-3.891) and 1.103 (95% CI of 1.028-1.183), respectively. PLT and PDW were independent prognosis protective factors for gastric cancer, with HR values of 0.998 (95% CI of 0.997-1.000) and 0.891 (95% CI of 0.797-0.996), respectively. Compared with type O blood patients, patients with type A blood, type B blood and type AB blood had 3.472 times (95% CI 2.562-4.706), 3.368 times (95% CI 2.454-4.624) and 4.407 times (95% CI 2.871-6.766) increased risk of death.

CONCLUSION

The results of NLR, PLT, PDW and ABO blood group can help to predict the survival of gastric cancer patients.

ABO blood type, smoking status, other risk factors and prognosis of pancreatic ductal adenocarcinoma

The aim of this observational study was to test whether ABO blood type was a prognostic factor for pancreatic ductal adenocarcinoma (PDAC) patients and whether other risk factors could influence pancreatic cancer patients' survival. This study included 610 patients who were diagnosed as pancreatic cancer and had undergone radical surgery. Patients' characteristics included age, gender, tumor stage, tumor grade, adenosquamous carcinoma (ASC) status, preoperative serum carbohydrate antigen 19-9 (CA19-9) levels, preoperative serum carcinoembryonic antigen (CEA) levels, ABO blood type, smoking status, and drinking status were analyzed in this study. Cox proportional hazards regression model and Kaplan-Meier method were used to evaluate the role of prognostic factors. For pancreatic cancer patients undergoing radical surgery, the overall survival was worse for ASC patients than PDAC patients (Log-rank = 11.315, P < .001). Compared with ASC patients (Log-rank < 0.001, P = .996), PDAC patients can benefit from chemotherapy (Log-rank = 17.665, P < .001). For PDAC patients, O blood type had better overall survival than non-O blood type (Log-rank = 4.153, P = .042). Moreover, the group with higher serum levels of CA19-9 had poor prognosis compared to another group with low serum CA19-9 (Log-rank = 4.122, P = .042). Higher CEA levels indicated poor prognosis (Log-rank = 13.618, P < .001). In conclusion, ASC status was associated with overall survival of pancreatic cancer patients and cannot benefit from postoperative chemotherapy. Non-O blood type was a prognostic factor for PDAC patients.

Overexpression of Epcam and CD133 Correlates with Poor Prognosis in Dual-phenotype Hepatocellular Carcinoma

Background: Dual-phenotype hepatocellular carcinoma (DPHCC) is associated with high rate of post-operative recurrence and low rate of survival, which may reflect the post-operative persistence of cancer stem cells (CSCs). Here we explored the potential correlation between DPHCC and expression of CSCs markers. Methods: In this retrospective study, we included 19 patients with DPHCC and 61 patients with non-DPHCC treated in 2015 by liver resection. Paraffin-embedded tumor tissue specimens were analyzed using immunohistochemistry as well as immunofluorescence double-staining. Rates of recurrence-free survival and overall survival were compared between the two groups using the Kaplan-Meier method, and expression of the CSC markers CD133, CD90, and EpCAM were compared using real-time quantitative PCR and western blotting. Results: Overall survival rates were significantly lower for patients with DPHCC than patients with non-DPHCC at 1 year (78.9% vs 93.4%), 2 years (52.6% vs 72.1%), and 3 years (42.1% vs 67.2%) (P = 0.019). Multivariate Cox proportional hazard modeling identified CK19 positivity (P = 0.016) and multiple nodules (P = 0.023) as independent predictors of poor recurrence-free survival. Independent predictors of poor overall survival were CK19 positivity (P = 0.032), Barcelona Clinic Liver Cancer stage C (P = 0.025) and carbohydrate antigen 19-9 (CA19-9) >37 ng/ml (P = 0.016). Expression of CD133 and EpCAM mRNA and protein were significantly higher in DPHCC tissue than non-DPHCC tissue, while CD90 expression was similar between the groups. Conclusions: These results suggest that DPHCC is associated with significantly lower overall survival than non-DPHCC, and that the poor prognosis among DPHCC patients may be related to the presence of CSCs expressing CD133 and EpCAM.

ABO Blood Type and the Long-term Outcomes of Pancreatic Cancer

Objective The long-term effect of the ABO blood type on the clinical course of patients with pancreatic cancer (PC) is inconclusive. This study aimed to determine whether or not the ABO blood type influences the long-term outcomes of PC in Japanese patients. Methods The medical records of Japanese patients with PC were reviewed. Data, including the age, sex, and outcomes, from the Ehime Pancreato-Cholangiology Study Group were analyzed. Results The mean age of the 406 patients was 71.0±10.5 years, and 220 (54.2%) were men. A total of 44.6%, 20.7%, 22.4%, and 12.3% had blood type A, B, O, and AB, respectively. The median survival time (MST) of patients with A alleles was shorter than that of patients with non-A alleles (p=0.048), especially among those who underwent resection (p=0.031). In contrast, no marked difference in the MST was noted among those who underwent chemotherapy and palliative care. Finally, a multivariate analysis confirmed A alleles as an independent factor associated with the long-term outcome of PC (p<0.05 in 2 different models). Conclusion The ABO blood type influenced the long-term outcomes of Japanese patients with PC, presumably due to its impact on disease onset and tumor behavior.

Cigarette Smoking and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis

Current evidence on cigarette smoking associated with pancreatic cancer mortality is limited. We searched MEDLINE, Web of Science, and Embase databases to identify relevant studies published through January 31, 2018. A random-effects model was used to estimate summary hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 20 studies were retrieved, involving 2,517,623 participants. Of these, more than 15,341 patients with pancreatic cancer died. Compared with never smokers, current (summary HR, 1.56; 95% CI, 1.34-1.83) and former (summary HR, 1.15; 95% CI, 1.06-1.26) smokers had elevated risk of total mortality in patients diagnosed with pancreatic cancer. This effect of cigarette smoking is observed both in the Western regions and the Asia-Pacific regions. This effect of smoking is independent of alcohol use, body mass index, and history of diabetes but is modified by tumor stage and study settings. Dose-response associations between smoking and pancreatic cancer mortality were revealed for smoking intensity, cumulative amount of cigarettes smoked, and duration of smoking. Cigarette smoking was associated with an increase in total mortality for patients with pancreatic cancer. Future studies should further clarify the role of smoking as an effect modifier in treatment trials of pancreatic cancer.

Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors

Pancreatic cancer is the seventh leading cause of cancer-related deaths worldwide. However, its toll is higher in more developed countries. Reasons for vast differences in mortality rates of pancreatic cancer are not completely clear yet, but it may be due to lack of appropriate diagnosis, treatment and cataloging of cancer cases. Because patients seldom exhibit symptoms until an advanced stage of the disease, pancreatic cancer remains one of the most lethal malignant neoplasms that caused 432,242 new deaths in 2018 (GLOBOCAN 2018 estimates). Globally, 458,918 new cases of pancreatic cancer have been reported in 2018, and 355,317 new cases are estimated to occur until 2040. Despite advancements in the detection and management of pancreatic cancer, the 5-year survival rate still stands at 9% only. To date, the causes of pancreatic carcinoma are still insufficiently known, although certain risk factors have been identified, such as tobacco smoking, diabetes mellitus, obesity, dietary factors, alcohol abuse, age, ethnicity, family history and genetic factors, Helicobacter pylori infection, non-O blood group and chronic pancreatitis. In general population, screening of large groups is not considered useful to detect the disease at its early stage, although newer techniques and the screening of tightly targeted groups (especially of those with family history), are being evaluated. Primary prevention is considered of utmost importance. Up-to-date statistics on pancreatic cancer occurrence and outcome along with a better understanding of the etiology and identifying the causative risk factors are essential for the primary prevention of this disease.

ABO Blood Group and Diabetes Mellitus Influence the Risk for Pancreatic Cancer in a Population from China

Background

The mechanism by which diabetes mellitus (DM) impacts the association between ABO blood types and pancreatic cancer is unclear.

Material/Methods

A retrospective case-control study of 264 patients with pancreatic cancer and 423 age- and sex-matched individuals with nonmalignant diseases was performed to assess whether ABO blood group and DM jointly contribute to pancreatic cancer risk.

Results

A multivariate analysis with adjustments for risk factors revealed that blood type, chronic pancreatitis, and DM were significantly associated with increased pancreatic cancer risk. The estimated adjusted odds ratios (AORs with 95% confidence intervals [CIs]) were 2.130 (1.409–3.220) for blood type A, 2.383 (1.313–4.325) for blood type AB, 1.518 (1.012–2.276) for DM, and 10.930 (1.202–99.405) for chronic pancreatitis. Blood type A significantly modified the risk for pancreatic cancer in individuals with DM (AOR, 3.506; 95% CI, 1.659–7.409).

Conclusions

The risk for pancreatic cancer was associated with ABO blood type, DM, and chronic pancreatitis in a Chinese population. The risk was greatest for individuals with blood type A and DM.

Metabolic syndrome and in-hospital outcomes among pancreatic cancer patients

AIMS

Metabolic Syndrome (MetS) is an important etiologic and prognostic factor for pancreatic cancer, but few studies have assessed health outcomes among hospitalized pancreatic cancer patients. We examined the associations between MetS and in-hospital outcomes, i.e. pancreatic resection, post-surgery complications, in-hospital mortality and discharge disposition among hospitalized patients with pancreatic cancer.

METHODS

Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) dataset from 2007 to 2011, we obtained data on 47,386 patients hospitalized with a primary diagnosis of pancreatic cancer. Descriptive statistics and multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals adjusting for age, race/ethnicity, and socioeconomic status.

RESULTS

Pancreatic cancer patients with MetS were more likely to undergo pancreatic resection (OR: 1.14, 95% CI: 1.04-1.25) compared to those without MetS. However they were less likely to experience post-surgical complications (OR: 0.90, 95% CI: 0.81-0.99), discharge to a skilled nursing facility (OR: 0.90, 95% CI: 0.83-0.93), and less likely to experience in-hospital mortality (OR: 0.52, 95% CI: 0.44-0.61) compared to those without MetS.

CONCLUSION

Hospitalized pancreatic cancer patients with a clinical diagnosis of MetS were more likely to receive pancreatic resection, and had reduced odds of post-surgical complications and in-hospital mortality. If confirmed in future studies, then better understanding of the biological mechanisms underlying this association will be needed, potentially leading to the development of clinical and/or molecular biomarkers to improve early diagnosis of pancreatic cancer and identify patients that may benefit from pancreatic resection.

Blood type, ABO genetic variants, and ovarian cancer survival

OBJECTIVE

Blood type A and the A1 allele have been associated with increased ovarian cancer risk. With only two small studies published to date, evidence for an association between ABO blood type and ovarian cancer survival is limited.

METHODS

We conducted a retrospective cohort study of Tumor Registry confirmed ovarian cancer cases from the Vanderbilt University Medical Center with blood type from linked laboratory reports and ABO variants from linked Illumina Exome BeadChip data. Associations with overall survival (OS) were quantified by hazard ratios (HR) and confidence intervals (CI) from proportional hazards regression models; covariates included age, race, stage, grade, histologic subtype, and year of diagnosis.

RESULTS

ABO phenotype (N = 694) and/or genotype (N = 154) data were available for 713 predominantly Caucasian (89.3%) cases. In multivariable models, blood type A had significantly better OS compared to either O (HR: 0.75, 95% CI: 0.60-0.93) or all non-A (HR: 0.77, 95% CI: 0.63-0.94) cases. Similarly, missense rs1053878 minor allele carriers (A2) had better OS (HR: 0.50, 95% CI: 0.25-0.99). Among Caucasians, this phenotype association was strengthened, but the genotype association was attenuated; instead, four variants sharing moderate linkage disequilibrium with the O variant were associated with better OS (HR: 0.62, 95% CI: 0.39-0.99) in unadjusted models.

CONCLUSIONS

Blood type A was significantly associated with longer ovarian cancer survival in the largest such study to date. This finding was supported by genetic analysis, which implicated the A2 allele, although O related variants also had suggestive associations. Further research on ABO and ovarian cancer survival is warranted.

Association between ABO blood group and HCV-related hepatocellular carcinoma risk in China

The ABO blood group has previously been reported to be associated with risk for certain malignancies; however, data about the risks for hepatocellular carcinoma (HCC) according to blood type are limited. Thus, we conducted a retrospective case-control study to investigate whether the ABO blood group contributes to hepatitis C virus (HCV) infection-induced HCC.From January 2010 to June 2016, 447 consecutive patients with chronic HCV infection were recruited. Of these patients, 217 had HCV-related HCC, and 230 had chronic hepatitis C (CHC) without HCC. We performed multivariate logistic regression to probe the association between the ABO blood group and HCC risk.Compared with subjects with blood type O, patients with blood type A had an adjusted odds ratio (AOR) of 3.301 (95% confidence interval [CI], 1.927-5.653) for HCC after adjusting for age and gender. We found statistically significant associations between blood type A and HCC risk for both men (AOR [95% CI] = 4.192 [1.959-8.973]) and women (AOR [95% CI] = 2.594 [1.231-5.466]), and for patients aged below 70 years (<60 years: AOR [95% CI] = 3.418 [1.338-8.734]; 60-69 years: AOR [95% CI] = 3.917 [1.730-8.867]).Thus, HCC risk is associated with ABO blood type in Chinese CHC patients, and CHC patients with blood type A are more susceptible to HCV-related HCC than patients with other blood types.

Is there an association between blood group and survival in pancreatic cancer?

BACKGROUND

An association between the ABO groups and pancreatic cancer has been shown previously, group A being significantly commoner in affected patients. We conducted the present study to investigate the prognostic effect of ABO blood group on overall survival of pancreas cancer patients.

METHODS

Patients who were diagnosed between 2005 and 2010 with pancreas cancer at Ankara Numune Education and Research Hospital were analyzed retrospectively. Patient demographics and ABO blood groups were obtained from medical charts.

RESULTS

Fifty pancreas cancer patients with known ABO blood group were included, 26 (52%) group A, 12 patients (24%) group 0, 9 (18%) group B, and 3 (6%) group AB. Blood group A pancreas cancer patient median age was 61.5 (39-80) years, with the median age of the other blood groups (B, AB,O) being 55.5 (32-74) years (p=0.14). 18% of patients with blood group A and11%of the other blood group patients had metastasis (p=0.17) at the time of diagnosis. The median overall survival of blood group A pancreas patients was significantly lower than the other blood group patients, 7.6 (95%CI: 5.0-10.2) months versus 29.0 (95%CI: 0.0-68.8) months (p=0.05).

CONCLUSIONS

Acccording to previously published cohort studies a relation may exist between ABO blood groups and cancer of pancreas. In this study we observed that pancreas cancer patients with blood group A have significantly worse overall survival than other blood groups.

The prognostic value of ABO blood group in cancer patients

The antigens of the ABO system are expressed on red blood cell membranes as well as on the surface of several other normal and pathological cells and tissues. Following the first clinical observations more than 60 years ago, the role of ABO blood group in cancer biology has been intensely studied by several investigators, and it is now widely recognised that ABO antigens are associated with the risk of developing several types of tumours, namely pancreatic and gastric cancers. However, whether this association also affects the clinical outcome of cancer patients is less certain. In this narrative review, based on literature data, we discuss the role of ABO blood types as prognostic biomarkers in different types of cancers. The current knowledge of the underlying pathogenic mechanisms of the association is also analysed.

Impact of ABO blood group on the prognosis of patients undergoing surgery for esophageal cancer

BACKGROUND

ABO blood type is an established prognostic factor in several malignancies, but its role in esophageal cancer (EC) is largely unknown. The aim of this study is to determine whether ABO blood group is associated with survival after esophagectomy for EC.

METHODS

A total of 406 patients who underwent surgery for EC were enrolled. The associations of ABO blood group with clinical and pathological variables were assessed using chi-square test. Associations of ABO blood group with the survival were estimated using univariable and multivariable Cox proportional hazards regression models.

RESULTS

The ABO blood group proportionally associated with the grade of EC tumor (P = 0.049). The ABO blood group status did not correlate with disease-free survival (DFS) in univariable analysis or multivariable analysis (P > 0.05). And there was no significant relationship between the ABO blood group and overall survival (OS) in univariable analysis or multivariable analysis (P > 0.05).

CONCLUSIONS

Our results suggested that no association between ABO blood group and the survival was observed in patients undergoing surgery for EC.

Association between HBsAg positivity and pancreatic cancer: a meta-analysis

BACKGROUND

Several studies have proposed an association between hepatitis B and pancreatic cancer. Although the spectrum of serological tests varied between studies, hepatitis B virus (HBV) surface antigen (HBsAg) test results were consistently reported. This meta-analysis evaluates the association between HBsAg positivity and pancreatic cancer.

METHODS

A systematic literature search was performed from inception through September 2013 for English language studies using the following terms: "hepatitis B," "HBsAg," "pancreatic cancer," and "pancreatic adenocarcinoma." Studies that have not reported cumulative odds ratio for the association of interest were excluded. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CI) were calculated using a random-effects model. Statistical heterogeneity and publication bias were addressed using the I2 statistic and Egger's weighted regression statistics, respectively.

RESULTS

We included two case-control studies and one cohort study, involving 1,636 patients with pancreatic cancer. The OR of developing pancreatic cancer was 1.50 (95% CI 1.21 to 1.87) for individuals who were HBsAg-positive. The type of study, case-control versus cohort, did not appear to influence the results. Only two of the three studies reported the association between anti-HBc positivity and pancreatic cancer. Our analysis revealed a nonsignificant increased risk of cancer in patients with positive anti-HBc status (OR 1.23, 95% CI 0.95-1.59). No statistically significant heterogeneity or publication bias was noted.

CONCLUSION

HBsAg positivity is associated with an increased risk of pancreatic cancer. Additional studies are needed to clearly define the association between chronic hepatitis B infection and pancreatic cancer. This could have important implications for both primary prevention and treatment of pancreatic cancer.

Ploidy and DNA index as prognostic factors in resected pancreatic ductal adenocarcinoma - a review of the literature

In Poland, pancreatic cancer is the seventh most common cause of cancer-related death amongst men and the sixth amongst women. Pancreatic cancer has an extremely poor prognosis. Radical surgery still remains the only way of curing pancreatic cancer, and this is possible to perform in just 20% of cases, i.e. those that present localised disease upon diagnosis. An average survival of ∼20 months post-resection and adjuvant chemotherapy has been observed in 10–15% of patients with tumours limited to the pancreas at the time of presentation. It is necessary to define strong prognostic factors to determine individual treatment and prognosis. In this paper we submit a review of the literature concerning the prognostic impact of the ploidy and the DNA index on the survival of patients who underwent resection of pancreatic ductal adenocarcinoma. However, the presented studies have produced conflicting results. Pancreatic cancer still remains a great challenge in medicine.

ABO blood types and cancer risk--a cohort study of 339,432 subjects in Taiwan

BACKGROUND

The associations of laboratory-based ABO phenotypes with cancer risks and mortality have not been systematically determined.

METHODS

The study subjects were 339,432 healthy individuals with laboratory-based blood types from a Taiwan cohort.

RESULTS

Compared to blood type O, blood type A was significantly associated with an elevated risk of stomach cancer incidence (Hazard Ratio [HR], 1.38 [95% CI, 1.11-1.72]) and mortality (HR, 1.38 [95% CI, 1.02-1.86]) compared with blood type O, after adjusting for age, sex, education, smoking, alcohol drinking, physical activity, and body mass index. Non-O blood types were associated with an elevated risk of pancreatic cancer, with blood type B reaching statistical significance for incidence (HR, 1.59 [95% CI, 1.02-2.48]) and mortality (HR, 1.63 [95% CI, 1.02-2.60]). In contrast, kidney cancer risk was inversely associated with blood type AB (HR, 0.41 [95% CI, 0.18-0.93]) compared to type O.

CONCLUSION

Cancer risks vary in people with different ABO blood types, with elevated risks of stomach cancer associated with blood type A and pancreatic cancer associated with non-O blood types (A, B, and AB).

Hepatitis B and C viruses are not risks for pancreatic adenocarcinoma

AIM: To investigate whether hepatitis B virus (HBV) and hepatitis C virus (HCV) increase risk of pancreatic ductal adenocarcinoma (PDAC).

METHODS: We recruited 585 patients with cytological and/or pathologically confirmed PDAC in National Taiwan University Hospital from September 2000 to September 2013, and 1716 age-, sex-, and race-matched controls who received a screening program in a community located in Northern Taiwan. Blood samples were tested for the presence of HCV antibodies (anti-HCV), HBV surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and hepatitis B core antigen (anti-HBc) in all cases and controls. The odds ratio (OR) of PDAC was estimated by logistic regression analysis with adjustment diabetes mellitus (DM) and smoking.

RESULTS: HBsAg was positive in 73 cases (12.5%) and 213 controls (12.4%). Anti-HCV was positive in 22 cases (3.8%) and 45 controls (2.6%). Anti-HBs was positive in 338 cases (57.8%) and 1047 controls (61.0%). The estimated ORs of PDAC in multivariate analysis were as follows: DM, 2.08 (95%CI: 1.56-2.76, P < 0.001), smoking, 1.36 (95%CI: 1.02-1.80, P = 0.035), HBsAg⁺/anti-HBc⁺/anti-HBs^-, 0.89 (95%CI: 0.89-1.68, P = 0.219), HBsAg^-/anti-HBc⁺/anti-HBs⁺, 1.03 (95%CI: 0.84-1.25, P = 0.802).

CONCLUSION: HBV and HCV infection are not associated with risk of PDCA after adjustment for age, sex, DM and smoking, which were independent risk factors of PDAC.

Diabetes type II, other medical conditions and pancreatic cancer risk: a prospective study in The Netherlands

Background:

To date, only a few risk factors for pancreatic cancer have been established. We examined prospectively relations between several medical conditions and pancreatic cancer incidence.

Methods:

In 1986, 120 852 participants completed a baseline questionnaire on cancer risk factors, including several self-reported physician diagnosed medical conditions. At baseline, a random subcohort of 5000 participants was selected using a case-cohort approach for analysis. After 16.3 years of follow-up, 448 pancreatic cancer cases (63% microscopically confirmed) were available for analysis.

Results:

Diabetes mellitus type II and hepatitis were positively associated with pancreatic cancer risk (multivariable-adjusted hazard ratio: 1.79; 95% confidence interval: 1.12–2.87 and hazard ratio: 1.37; 95% confidence interval: 1.04–1.81, respectively). Furthermore, a positive trend in risk with increasing years of diagnosis of diabetes (P=0.004) and of hepatitis (P=0.02) was observed. However, an inverse association was observed between hypertension and pancreatic cancer risk, this was found among microscopically confirmed cases only (hazard ratio: 0.66; 95% confidence interval: 0.49–0.90), while years since diagnosis of hypertension significantly decreased cancer risk (P for trend=0.02).

Conclusion:

In this prospective study, a positive association was observed between self-reported physician diagnosed diabetes mellitus type II and hepatitis and pancreatic cancer risk, whereas an inverse association was observed with hypertension.

Prediagnostic body mass index and pancreatic cancer survival

PURPOSE

Although obesity is associated with increased incidence of pancreatic cancer, studies have not prospectively evaluated prediagnostic body mass index (BMI) and survival.

PATIENTS AND METHODS

We analyzed survival by prediagnostic BMI assessed in 1986 among 902 patients from two large prospective cohorts diagnosed from 1988 to 2010. We estimated hazard ratios (HRs) for death using Cox proportional hazards models, with adjustment for age, sex, race/ethnicity, smoking, diagnosis year, and stage. We evaluated the temporal association of BMI with survival by grouping reported BMI by 2-year lag-time intervals before diagnosis.

RESULTS

The multivariable-adjusted HR for death was 1.53 (95% CI, 1.11 to 2.09) comparing patients with BMI ≥ 35 kg/m(2) with those with BMI < 25 kg/m(2) (P trend = .001), which was similar after adjustment for stage. The association of BMI with survival was stronger with longer lag times between reported BMI and cancer diagnosis. Among patients with BMI collected 18 to 20 years before diagnosis, HR for death was 2.31 (95% CI, 1.48 to 3.61; P trend < .001), comparing obese with healthy-weight patients. No statistically significant differences were seen by cohort, smoking status, or stage, although the association was stronger among never-smokers (HR, 1.61; 95% CI, 1.01 to 2.57; P trend = .002) than ever-smokers (HR, 1.36; 95% CI, 0.86 to 2.15; P trend = .63), comparing BMI ≥ 35 kg/m(2) with BMI < 25 kg/m(2). Higher prediagnostic BMI was associated with more advanced stage at diagnosis, with 72.5% of obese patients presenting with metastatic disease versus 59.4% of healthy-weight patients (P = .02).

CONCLUSION

Higher prediagnostic BMI was associated with statistically significantly decreased survival among patients with pancreatic cancer from two large prospective cohorts.

Hepatitis B or C viral infection and risk of pancreatic cancer: A meta-analysis of observational studies

AIM: To investigate if there is an association between hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the risk of pancreatic cancer.

METHODS: All relevant studies published before 11 October, 2012 were identified by a systematic search of MEDLINE, EMBASE, BIOSIS Previews and the Cochrane Library databases and with cross-referencing. The observational studies that reported RR or OR estimates with 95%CIs for the association between HBV or HCV and pancreatic cancer were included. A random-effects model was used to summarize meta-analytic estimates. The Newcastle-Ottawa quality assessment scale was applied to assess the quality of the methodology in the included studies.

RESULTS: A total of 8 eligible studies were selected for meta-analysis. Overall, chronic hepatitis B and inactive hepatitis B surface antigen (HBsAg) carrier state (HBsAg positive) had a significantly increased risk of pancreatic cancer with OR of 1.20 (95%CI: 1.01-1.39), especially in the Chinese population (OR = 1.30, 95%CI: 1.05-1.56). Past exposure to HBV (possible occult HBV infection) had an increased OR of pancreatic cancer risk (OR = 1.24, 95%CI: 1.05-1.42), especially among those patients without natural immunity [anti hepatitis B core (HBc) positive/hepatitis B surface antibody (anti HBs) negative], with OR of 1.67 (95%CI: 1.13-2.22). However, past exposure to HBV with natural immunity (anti-HBc positive/anti-HBs positive) had no association with pancreatic cancer development, with OR 0.98 (95%CI: 0.80-1.16), nor did the HBV active replication (hepatitis B e antigen positive status), with OR 0.98 (95%CI: 0.27-1.68). The risk of pancreatic cancer among anti-HBs positive patients was significantly lower than among anti-HBs negative patients (OR = 0.54, 95%CI: 0.46-0.62). Past exposure to HCV also resulted in an increased risk of pancreatic cancer (OR = 1.26, 95%CI: 1.03-1.50). Significant between-study heterogeneity was observed. Evidence of publication bias for HBV/HCV infection-pancreatic cancer association was not found.

CONCLUSION: Chronic HBV and HCV infection increases pancreatic cancer risk. Our findings underscore the need for more studies to confirm this potential relationship.

Phase I/II study of albumin-bound nab-paclitaxel plus gemcitabine administered to Chinese patients with advanced pancreatic cancer

PURPOSE

The primary objective of this study was to evaluate the dose-limiting toxicities (DLTs) and identify the maximum-tolerated dose (MTD) and recommended dose of nab-paclitaxel plus gemcitabine as a first-line treatment in Chinese patients with advanced pancreatic ductal adenocarcinoma (PDA).

METHODS

Patients with previously untreated advanced PDA were treated with nab-paclitaxel followed by gemcitabine (1,000 mg/m(2)) administered intravenously for 30 min on days 1 and 8 and repeated every 21 days.

RESULTS

Patients received nab-paclitaxel at the following dose levels: 80 mg/m(2) (n = 3), 100 mg/m(2) (n = 6), and 120 mg/m(2) (n = 12). The DLTs evaluated were elevated alanine aminotransferase and febrile neutropenia. However, there had no two out of three to six patients experienced DLTs, the MTD was not met. A total of 93 cycles were administered. The most common grade 3/4 toxicities were neutropenia (9.52 %), thrombocytopenia (4.76 %), and sensory neuropathy (4.76 %). For 12 patients receiving 120 mg/m(2), the overall response rate and disease control rate were 41.67 and 83.33 %, respectively, and the median progression-free survival and overall survival were 5.23 and 12.17 months, respectively.

CONCLUSIONS

Treatment with albumin-bound nab-paclitaxel (120 mg/m(2)) plus gemcitabine has a favorable safety profile with an encouraging antitumor effect in Chinese patients.

Association between hepatitis B or hepatitis C virus infection and risk of pancreatic adenocarcinoma development: a systematic review and meta-analysis

BACKGROUND

Pancreatic adenocarcinoma (PAC) is an aggressive cancer with a poor prognosis. To date, PAC causes are still largely unknown. Antigens and replicative sequences of oncogenic hepatitis B (HBV) and hepatitis C (HCV) virus were detected in different extra-hepatic tissues, including pancreas.

OBJECTIVE

a systematic review and meta-analysis of epidemiological studies assessing PAC risk in patients with HBV/HCV chronic infections.

METHODS

In September 2012, we extracted the articles published in Medline, Embase and the Cochrane Library, using the following search terms: "chronic HBV" and "HCV", "hepatitis", "PAC", "risk factors", "epidemiology". Only case/control (C/C), prospective/retrospective cohort studies (PCS/RCS) written in English were collected.

RESULTS

four hospital-based C/C studies and one PCS, in HBV-infected patients and two hospital-based C/C studies and one RCS in HCV-infected subjects met inclusion criteria. In these studies HBsAg positivity enhanced significantly PAC risk (RR = 1.18, 95% CI:1.04-1.33), whereas HBeAg positivity (RR = 1.31, 95% CI:0.85-2.02) as well as HBsAg negative/HBcAb positive/HBsAb positive pattern (RR = 1.12, 95% CI:0.78-1.59) and HBsAg negative/HBcAb positive/HBsAb negative pattern (RR = 1.30, 95% CI:0.93-1.84) did not. Relationship between PAC risk and anti-HCV positivity was not significant, although it reached a borderline value (RR = 1.160, 95% CI:0.99-1.3).

CONCLUSIONS

HBV/HCV infection may represent a risk factor for PAC, but the small number of available researches, involving mainly populations of Asian ethnicity and the substantial variation between different geographical areas in seroprevalence of HBV/HCV-antigens/antibodies and genotypes are limiting factors to present meta-analysis.