Prediagnostic Inflammation and Pancreatic Cancer Survival

Chen Yuan, Vicente Morales-Oyarvide, Natalia Khalaf, Kimberly Perez, Fred K. Tabung, Gloria Y.F. Ho, Charles Kooperberg, Aladdin H. Shadyab, Lihong Qi, Peter Kraft, Howard D. Sesso, Edward L. Giovannucci, Jo Ann E. Manson, Meir J. Stampfer, Kimmie Ng, Charles S. Fuchs, Brian M. Wolpin, Ana Babic

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Chronic inflammation may promote initiation and progression of pancreatic cancer, but no studies have examined the association between inflammation in the period before diagnosis and pancreatic cancer survival. METHODS: We prospectively examined the association of prediagnostic plasma levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α receptor 2 with survival among 492 participants from 5 large US prospective cohort studies who developed pancreatic cancer. Using an empirical dietary inflammatory pattern (EDIP) score, we evaluated whether long-term proinflammatory diets were associated with survival among 1153 patients from 2 of the 5 cohorts. Cox proportional hazards regression was used to estimate hazard ratios for death with adjustment for potential confounders. All statistical tests were 2-sided. RESULTS: Higher prediagnostic levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α receptor 2 were individually associated with reduced survival (Ptrend = .03, .01, and .04, respectively). Compared with patients with a combined inflammatory biomarker score of 0 (all 3 marker levels below medians), those with a score of 3 (all 3 marker levels above medians) had a hazard ratio for death of 1.57 (95% confidence interval = 1.16 to 2.12; Ptrend = .003), corresponding to median overall survival times of 8 vs 5 months. Patients consuming the most proinflammatory diets (EDIP quartile 4) in the prediagnostic period had a hazard ratio for death of 1.34 (95% confidence interval = 1.13 to 1.59; Ptrend = .01), compared with those consuming the least proinflammatory diets (EDIP quartile 1). CONCLUSION: Prediagnostic levels of inflammatory biomarkers and long-term proinflammatory diets were inversely associated with pancreatic cancer survival.

Original languageEnglish (US)
Pages (from-to)1186-1193
Number of pages8
JournalJournal of the National Cancer Institute
Issue number9
StatePublished - Sep 4 2021

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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