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Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis
Previous studies have suggested that β-adrenergic signaling may regulate the growth of various cancers. The aim of our study is to investigate the association between the incidental use of beta-blockers for various conditions on the overall survival of patients with pancreatic ductal adenocarcinoma...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807087/ https://www.ncbi.nlm.nih.gov/pubmed/33441781 http://dx.doi.org/10.1038/s41598-020-79999-0 |
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author | Yang, Anthony Zylberberg, Haley M. Rustgi, Sheila D. Amin, Sunil P. Bar-Mashiah, Ariel Boffetta, Paolo Lucas, Aimee L. |
author_facet | Yang, Anthony Zylberberg, Haley M. Rustgi, Sheila D. Amin, Sunil P. Bar-Mashiah, Ariel Boffetta, Paolo Lucas, Aimee L. |
author_sort | Yang, Anthony |
collection | PubMed |
description | Previous studies have suggested that β-adrenergic signaling may regulate the growth of various cancers. The aim of our study is to investigate the association between the incidental use of beta-blockers for various conditions on the overall survival of patients with pancreatic ductal adenocarcinoma (PDAC). Patients with histologically-confirmed PDAC between 2007 and 2011 were extracted from Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linked database. Kaplan Meier and multivariable Cox Proportional-Hazard models were used to examine the association between beta-blocker usage before diagnosis and overall survival adjusting for appropriate confounders. As an additional analysis we also examined continuous beta-blocker use before and after diagnosis. From 2007 to 2011, 13,731 patients were diagnosed with PDAC. Of these, 7130 patients had Medicare Part D coverage in the 6-month period before diagnosis, with 2564 (36%) of these patients using beta-blockers in this period. Patients receiving beta-blockers had a mean survival time of 5.1 months compared to 6 months for non-users (p < 0.01). In multivariable analysis, beta-blockers usage was not associated with improved survival (Hazard Ratio (HR) 1.04, 95%, Confidence Interval (CI) 0.98–1.1, p = 0.2). When patients were stratified by conditions with indications for beta-blocker usage, such as hypertension, coronary artery disease and cardiac arrhythmia, differences in survival were insignificant compared to non-users in all groups (p > 0.05). After stratification by receptor selectivity, this lack of association with survival persisted (p > 0.05 for all). As a subgroup analysis, looking at patients with continuous Medicare Part D coverage who used beta-blockers in the 6-month period before and after cancer diagnosis, we identified 7085 patients, of which 1750 (24.7%) had continuous beta blocker use. In multivariable analysis, continuous beta-blockers usage was associated with improved survival (Hazard Ratio (HR) 0.86, 95%, Confidence Interval (CI) 0.8–0.9, p < 0.01). Beta-blocker usage before diagnosis does not confer a survival advantage in patients with PDAC, though continuous use before and after diagnosis did confer a survival advantage. Prospective studies into the mechanism for this advantage are needed. |
format | Online Article Text |
id | pubmed-7807087 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-78070872021-01-14 Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis Yang, Anthony Zylberberg, Haley M. Rustgi, Sheila D. Amin, Sunil P. Bar-Mashiah, Ariel Boffetta, Paolo Lucas, Aimee L. Sci Rep Article Previous studies have suggested that β-adrenergic signaling may regulate the growth of various cancers. The aim of our study is to investigate the association between the incidental use of beta-blockers for various conditions on the overall survival of patients with pancreatic ductal adenocarcinoma (PDAC). Patients with histologically-confirmed PDAC between 2007 and 2011 were extracted from Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linked database. Kaplan Meier and multivariable Cox Proportional-Hazard models were used to examine the association between beta-blocker usage before diagnosis and overall survival adjusting for appropriate confounders. As an additional analysis we also examined continuous beta-blocker use before and after diagnosis. From 2007 to 2011, 13,731 patients were diagnosed with PDAC. Of these, 7130 patients had Medicare Part D coverage in the 6-month period before diagnosis, with 2564 (36%) of these patients using beta-blockers in this period. Patients receiving beta-blockers had a mean survival time of 5.1 months compared to 6 months for non-users (p < 0.01). In multivariable analysis, beta-blockers usage was not associated with improved survival (Hazard Ratio (HR) 1.04, 95%, Confidence Interval (CI) 0.98–1.1, p = 0.2). When patients were stratified by conditions with indications for beta-blocker usage, such as hypertension, coronary artery disease and cardiac arrhythmia, differences in survival were insignificant compared to non-users in all groups (p > 0.05). After stratification by receptor selectivity, this lack of association with survival persisted (p > 0.05 for all). As a subgroup analysis, looking at patients with continuous Medicare Part D coverage who used beta-blockers in the 6-month period before and after cancer diagnosis, we identified 7085 patients, of which 1750 (24.7%) had continuous beta blocker use. In multivariable analysis, continuous beta-blockers usage was associated with improved survival (Hazard Ratio (HR) 0.86, 95%, Confidence Interval (CI) 0.8–0.9, p < 0.01). Beta-blocker usage before diagnosis does not confer a survival advantage in patients with PDAC, though continuous use before and after diagnosis did confer a survival advantage. Prospective studies into the mechanism for this advantage are needed. Nature Publishing Group UK 2021-01-13 /pmc/articles/PMC7807087/ /pubmed/33441781 http://dx.doi.org/10.1038/s41598-020-79999-0 Text en © The Author(s) 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Yang, Anthony Zylberberg, Haley M. Rustgi, Sheila D. Amin, Sunil P. Bar-Mashiah, Ariel Boffetta, Paolo Lucas, Aimee L. Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis |
title | Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis |
title_full | Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis |
title_fullStr | Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis |
title_full_unstemmed | Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis |
title_short | Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis |
title_sort | beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807087/ https://www.ncbi.nlm.nih.gov/pubmed/33441781 http://dx.doi.org/10.1038/s41598-020-79999-0 |
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