Proton pump inhibitors on pancreatic cancer risk and survival |
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| Affiliation: | 1. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA;2. Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA;3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA;4. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA;5. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;6. Tel Aviv University, Tel Aviv, Israel;1. Registre général des Cancers de Guadeloupe, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe;2. Service d’anatomopathologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe;3. Service d’Oncologie-Radiothérapie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe;4. Service de Gynécologie-Obstétrique, Centre Hospitalier de la Basse-Terre, Guadeloupe;5. Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe;6. Institut National de la Santé et de la Recherche Médicale Inserm U1085 - IRSET, Campus Universitaire de Fouillole, Guadeloupe;1. Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;2. School of Pharmacy, Queen’s University Belfast, Northern Ireland, United Kingdom;3. Centre of Excellence for Public Health (NI), Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;1. Division of Population Science, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, United States;2. Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, United States;3. Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, United States;1. University of Tampere, School of Health Sciences, Tampere, Finland;2. Department of Clinical Chemistry, Helsinki University Central Hospital, Finland;3. Tampere University Hospital, Department of Urology and University of Tampere, Medical School, Tampere, Finland;4. Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands;5. Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden;6. Memorial Sloan-Kettering Cancer Centre, Department of Surgery and Department of Epidemiology and Biostatistics, New York, NY, USA;7. Finnish Cancer Registry, Helsinki, Finland;1. Department of Epidemiology, Fielding School of Public Health, University of California, CA, USA;2. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;3. Division of Pediatric Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA;1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA;2. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA |
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| Abstract: | BackgroundHypergastrinemia may promote the development and progression of pancreatic cancer. Proton pump inhibitor (PPI) therapy is known to cause hypergastrinemia. We sought to determine the association between PPI therapy and the risk of developing pancreatic cancer as well as survival following pancreatic cancer diagnosis.MethodsWe conducted a nested case-control study and a retrospective cohort study in The Health Improvement Network (THIN), a medical records database representative of the UK population. In the case-control study, each patient with incident pancreatic cancer was matched with up to four controls based on age, sex, practice site and both duration and calendar time of follow-up using incidence density sampling. The odds ratios (ORs) and 95% confidence intervals (CIs) for pancreatic cancer risk associated with PPI use were estimated using multivariable conditional logistic regression. The retrospective cohort study compared the survival of pancreatic cancer patients according to their PPI exposure at the time of diagnosis. The effect of PPI use on pancreatic cancer survival was assessed using a multivariable Cox regression analysis.ResultsThe case-control study included 4113 cases and 16,072 matched controls. PPI use was more prevalent in cases than controls (53% vs. 26% active users). Adjusting for diabetes, smoking, alcohol use and BMI, PPI users including both former users and active users with longer cumulative PPI use had a higher risk of pancreatic cancer compared to non-users. When assessing survival following pancreatic cancer diagnosis, only short-term, active users had a modest decrease in survival.ConclusionsLong-term PPI therapy may be associated with pancreatic cancer risk. While PPI users recently started on treatment had a slightly worse survival, this result likely is from reverse causation. |
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| Keywords: | Pancreatic cancer Proton pump inhibitors Risk Survival |
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