Pre-diagnosis diabetes, life-course body mass index and physical activity, and pancreatic cancer survival in older adults
Menée à partir de données portant sur 1 522 patients atteints d'un adénocarcinome canalaire pancréatique, cette étude analyse l'association entre la présence d'un diabète avant le diagnostic de cancer, l'indice de masse corporelle, l'activité physique tout au long de la vie et la survie
Background: Diabetes and excess body-weight are established risk factors for pancreatic ductal adenocarcinoma (PDAC); however, few studies have evaluated their association with PDAC survival. None have examined pre-diagnosis body size and physical activity across the adult life-course with PDAC survival.
Methods: We evaluated survival by pre-diagnosis self-reported diabetes, and adult life-course body mass index (BMI, kg/m2) and leisure-time physical activity (LTPA) from late adolescence to older age. We determined trajectories for BMI and LTPA using latent-class modeling. We included 2,522 participants diagnosed with PDAC in the National Institutes of Health (NIH)-AARP cohort between 1996 and 2018. Vital status was followed through December 31, 2019. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for PDAC survival using multivariable Cox proportional hazard models. Significance tests were 2-sided.
Results: Diabetes (vs without diabetes) was associated with reduced PDAC survival (HR = 1.36; 95% CI: 1.17, 1.59) with similar associations by sex. BMI and LTPA and their trajectories were not associated with PDAC survival. Among patients with unknown cancer stage (n = 1385), compared to low-normal BMI (≥18.5-<22.5), obesity at age 18 (HR = 1.56; 95% CI: 1.09, 2.22) and high normal, overweight, and obese BMI at ages 51-70 (HRs=1.33-1.56) were associated with reduced PDAC survival.
Conclusions: Pre-diagnosis diabetes was associated with reduced PDAC survival. Life-course BMI and LTPA were not associated with PDAC survival overall. Higher early- and older-adulthood BMIs were associated with poorer survival among unstaged patients; however, stage is an important determinant of survival that we were unable to control for in this group.
JNCI Cancer Spectrum , résumé, 2025