Pancreas

Gut. 2023;72(3):512–21

Tan PS, Garriga C, Clift A, Liao W, Patone M, Coupland C, Bashford-Rogers R, Sivakumar S, Hippisley-Cox J

Temporality of body mass index, blood tests, comorbidities and medication use as early markers for pancreatic ductal adenocarcinoma (PDAC): A nested case-control study

Objective: Prior studies identified clinical factors associated with increased risk of pancreatic ductal adenocarcinoma (PDAC). However, little is known regarding their time-varying nature, which could inform earlier diagnosis. This study assessed temporality of body mass index (BMI), blood-based markers, comorbidities and medication use with PDAC risk.
Design: The authors performed a population-based nested case-control study of 28,137 PDAC cases and 261,219 matched-controls in England. They described the associations of biomarkers with risk of PDAC using fractional polynomials and 5-year time trends using joinpoint regression. Associations with comorbidities and medication use were evaluated using conditional logistic regression.
Results: Risk of PDAC increased with raised HbA1c, liver markers, white blood cell and platelets, while following a U-shaped relationship for BMI and hemoglobin. Five-year trends showed biphasic BMI decrease and HbA1c increase prior to PDAC; early gradual changes 2–3 years prior, followed by late rapid changes 1–2 years prior. Liver markers and blood counts (white blood cell, platelets) showed monophasic rapid increase approximately 1 year prior. Recent diagnosis of pancreatic cyst, pancreatitis, type 2 diabetes and initiation of certain glucose-lowering and acid-regulating therapies were associated with highest risk of PDAC.

Conclusion: Risk of pancreatic ductal adenocarcinoma (PDAC) increased with raised HbA1c, liver markers, white blood cell and platelets, while followed a U-shaped relationship for body mass index (BMI) and hemoglobin. BMI and HbA1c derange biphasically approximately 3 years prior while liver markers and blood counts (white blood cell, platelets) derange monophasically approximately 1 year prior to PDAC. Profiling these in combination with their temporality could inform earlier PDAC diagnosis.

Prof. Dr. J. Hippisley-Cox, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK,
E-Mail: julia.hippisley-cox@phc.ox.ac.uk

DOI: DOI: 10.1136/gutjnl-2021-326522

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Prospective, multi-institutional, real-time next-generation sequencing of pancreatic cyst fluid reveals diverse genomic alterations that improve the clinical management of pancreatic cysts

Gastroenterology. 2023;164(1):117–33.e7

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Pancreas

Randomized study of temozolomide or temozolomide and capecitabine in patients with advanced pancreatic neuroendocrine tumors (ECOG-ACRIN E2211)

J Clin Oncol. 2023;41(7):1359–69