P0132 - Effect of Proton Pump Inhibitor Use on Colorectal Cancer Survival. a Retrospective Study of a Multi-Racial Population

Adham E. Obeidat, MD¹, Gabriel Monti, BSc², Horyun Choi, MD¹, Sandeep Randhawa, MD¹, Jared Acoba, MD^3
1University of Hawaii, Honolulu, HI; ²University of Hawaii School of Medicine, Honolulu, HI; ³University of Hawaii Cancer Center, Honolulu, HI

Introduction: Chronic proton pump inhibitor (PPI) use is increasing in the general population. Chronic PPI use can lead to hypergastrinemia, which has been purported to increase the risk of developing colorectal cancer (CRC), but little is known about the effect of PPI use on CRC survival. A retrospective study by Graham et al., suggested a potential adverse effect of PPI use on CRC patients, however that study had a limited sample size and further investigation is warranted. In this retrospective analysis of a multi-racial CRC population, we studied the association of PPI use and survival.

Methods: This is a retrospective chart review of 1050 patients diagnosed with CRC from January 2007 to December 2020. Kaplan-Meier curve was created to study the association of PPI exposure with overall survival (OS). Univariate and multivariate Cox proportional hazards regression analyses were performed to investigate predictors of survival.

Results: Of the 1050 patients with CRC, 54.6% were males, 22.5% were White, 44.7% Asian, and 15.4% Pacific-Islander. Mean BMI was 26.71. Two hundred and sixty three patients had a history of PPI use; 97 of them had more than one year exposure prior to diagnosis. Moreover, 6.3% had hypertension, 53% had hyperlipidemia, 26.5% had diabetes mellitus and 12.6% had chronic kidney disease.

There was no difference in 1, 3 and 5-year OS of PPI users compared to non-users, p= 0.3. Age, grade, stage, and not having surgery were associated with worse OS. Survival was not associated with race, gender, insurance status, comorbidities, or the absence of chemotherapy.

Discussion: In this analysis of a multi-racial CRC population, we found no association between PPI use and OS. This is contrary to the published literature. A prospective study could lead to a better understanding of the prognostic role of PPI use among CRC patients.


Figure: Figure 1. Kaplan-Meier curve showing survival outcomes according to PPI use. Log rank p value = 0.3

	Univariate		Multivariate
Characteristic	HR (95% CI)	P Value	HR (95% CI)	P Value
Gender	0.850 (0.699-1.034)	0.105
Age	1.030 (1.022-1.038)	< 0.001	1.036 (1.027-1.044)	< 0.001
Race (Reference= white)
Asian	0.967 (0.763-1.225)	0.778
Native Hawaiian/other pacific-islander	1.032 (0.760-1.401	0.842
Grade (Reference= G 1-2)
G 3-4	1.705 (1.342-2.167)	< 0.001	1.375 (1.078-1.754)	0.01
Stage (continuous)	1.936 (1.733-2.163)	< 0.001	1.803 (1.603-2.029)	< 0.001
Surgery (Reference= no)	0.147 (0.112-0.194)	< 0.001	0.250 (0.186-0.338)	< 0.001
Chemotherapy (Reference= no)	1.115 (0.918-1.355)	0.273
PPI	1.130 (0.909-1.406)	0.269	1.095 (0.880-1.363)	0.415
HTN	1.065 (0.870-1.304)	0.541
HLD	0.863 (0.710-1.049)	0.138
DM	1.002 (0.804-1.248)	0.988
CKD	1.283 (0.983-1.676)	0.067

Table: Univariate and Multivariate Cox Regression Model for Overall Survival.
P Value in bold= significant.
PPI=Proton pump inhibitor.
HTNf Hypertension.
HLD= Hyperlipidemia.
DM= Diabetes mellitus.
CKD= Chronic kidney disease.


Disclosures:
Adham Obeidat indicated no relevant financial relationships.
Gabriel Monti indicated no relevant financial relationships.
Horyun Choi indicated no relevant financial relationships.
Sandeep Randhawa indicated no relevant financial relationships.
Jared Acoba indicated no relevant financial relationships.


Adham E. Obeidat, MD¹, Gabriel Monti, BSc², Horyun Choi, MD¹, Sandeep Randhawa, MD¹, Jared Acoba, MD³. P0132 - Effect of Proton Pump Inhibitor Use on Colorectal Cancer Survival. a Retrospective Study of a Multi-Racial Population, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.