BACKGROUND: Type 2 diabetes mellitus has been associated with an excess risk of pancreatic cancer, but the magnitude of the risk and the time-risk relationship are unclear, and there is limited information on the role of antidiabetic medications. PATIENTS AND METHODS: We analyzed individual-level data from 15 case-control studies within the Pancreatic Cancer Case-Control Consortium, including 8305 cases and 13 987 controls. Pooled odds ratios (ORs) were estimated from multiple logistic regression models, adjusted for relevant covariates. RESULTS: Overall, 1155 (15%) cases and 1087 (8%) controls reported a diagnosis of diabetes 2 or more years before cancer diagnosis (or interview, for controls), corresponding to an OR of 1.90 (95% confidence interval, CI, 1.72-2.09). Consistent risk estimates were observed across strata of selected covariates, including body mass index and tobacco smoking. Pancreatic cancer risk decreased with duration of diabetes, but a significant excess risk was still evident 20 or more years after diabetes diagnosis (OR 1.30, 95% CI 1.03-1.63). Among diabetics, long duration of oral antidiabetic use was associated with a decreased pancreatic cancer risk (OR 0.31, 95% CI 0.14-0.69, for ≥15 years). Conversely, insulin use was associated with a pancreatic cancer risk in the short term (OR 5.60, 95% CI 3.75-8.35, for <5 years), but not for longer duration of use (OR 0.95, 95% CI 0.53-1.70, for ≥15 years). CONCLUSION: This study provides the most definitive quantification to date of an excess risk of pancreatic cancer among diabetics. It also shows that a 30% excess risk persists for more than two decades after diabetes diagnosis, thus supporting a causal role of diabetes in pancreatic cancer. Oral antidiabetics may decrease the risk of pancreatic cancer, whereas insulin showed an inconsistent duration-risk relationship.
Diabetes, antidiabetic medications, and pancreatic cancer risk : an analysis from the International Pancreatic Cancer Case-Control Consortium / C. Bosetti, V. Rosato, D. Li, D. Silverman, G.M. Petersen, P.M. Bracci, R.E. Neale, J. Muscat, K. Anderson, S. Gallinger, S.H. Olson, A.B. Miller, H. Bas Bueno-de-Mesquita, G. Scelo, V. Janout, I. Holcatova, P. Lagiou, D. Serraino, E. Lucenteforte, E. Fabianova, P. Ghadirian, P.A. Baghurst, W. Zatonski, L. Foretova, E. Fontham, W.R. Bamlet, E.A. Holly, E. Negri, M. Hassan, A. Prizment, M. Cotterchio, S. Cleary, R.C. Kurtz, P. Maisonneuve, D. Trichopoulos, J. Polesel, E.J. Duell, P. Boffetta, C. La Vecchia. - In: ANNALS OF ONCOLOGY. - ISSN 0923-7534. - 25:10(2014 Oct), pp. 2065-2072.
|Titolo:||Diabetes, antidiabetic medications, and pancreatic cancer risk : an analysis from the International Pancreatic Cancer Case-Control Consortium|
ROSATO, VALENTINA (Secondo)
|Parole Chiave:||case–control study ; diabetes ; insulin ; oral antidiabetics ; pancreatic cance r; pooled analysis|
|Settore Scientifico Disciplinare:||Settore MED/01 - Statistica Medica|
|Data di pubblicazione:||ott-2014|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/annonc/mdu276|
|Appare nelle tipologie:||01 - Articolo su periodico|