Prediagnosis diabetes, life-course body mass index and physical activity, and pancreatic cancer survival in older adults.
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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. No studies have examined prediagnosis body size and physical activity across the adult life course and their impact on PDAC survival. METHODS: We evaluated survival by prediagnosis self-reported diabetes and adult life course body mass index (BMI) and leisure-time physical activity from late adolescence to older age (eg, ≥50 years). We determined trajectories for BMI and leisure-time physical activity using latent class modeling. We included 2522 participants diagnosed with PDAC in the National Institutes of Health-AARP cohort between 1996 and 2018. Vital status was followed through December 31, 2019. We calculated hazard ratios (HRs) and 95% 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 to 1.59), with similar associations by sex. Body mass index and leisure-time physical activity and their trajectories were not associated with PDAC survival. Among patients with unknown cancer stage (n = 1385), compared with low to normal BMI (≥18.5 to <22.5), obesity at age 18 years (HR = 1.56, 95% CI = 1.09 to 2.22) and high normal, overweight, and obese BMI at ages 51 to 70 years (HR = 1.33 to 1.56) were associated with reduced PDAC survival. CONCLUSIONS: Prediagnosis diabetes was associated with reduced PDAC survival. Life-course BMI and leisure-time physical activity were not associated with PDAC survival overall. Higher early-adulthood and older-adulthood BMIs were associated with poorer survival among patients with unstaged disease; however, stage is an important determinant of survival that we were unable to control for in this group.