Abstract
Most pancreatic ductal adenocarcinoma cases are unresectable at the time of diagnosis. Only early diagnosis and curative resection can help prolong survival. We tried to find out useful clinical clues of pre-symptomatic area prior to pancreatic cancer diagnosis compared to normal controls. Of 4799 patients diagnosed with pancreatic cancer between 1995 and 2014 at the Samsung Medical Center, 51 were selected for study. They had no symptoms at diagnosis and underwent computed tomography 6 to 36 months prior to diagnosis for reasons other than cancer diagnosis. We selected 288 control subjects who underwent computed tomography during the same period. Data were retrospectively reviewed included various variables. Fasting blood sugar (171.8 ± 97.5 vs. 115.8 ± 34.8 units, p < 0.05), new onset diabetes mellitus within 3 years (12/51 (23.5%) vs. 17/181 (9.8%), p < 0.05), carbohydrate antigen 19-9 level (609.5 ± 2342.5 vs. 17.0 ± 26.2, p = 0.08), main pancreatic duct dilatation (26/51 (51.0%) vs. 57/181 (31.5%), p < 0.05) in computed tomography scan were higher in pancreatic cancer group than in normal group, respectively. In multi-variate analysis, carbohydrate antigen 19-9, new onset diabetes mellitus (<3 years), and segmental main pancreatic duct dilatation were independent risk factors for pancreatic cancer. Our study concluded that independent risk factors for pancreatic cancer were elevated carbohydrate antigen 19-9, new onset diabetes mellitus (<3 years), and local main pancreatic ductal dilatation on computed tomography scan.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) has a low incidence but is frequently fatal.The dismal prognosis is mainly because 80–90% of patients have unresectable disease at the time of disease diagnosis [1].The association between diabetes mellitus (DM) and PDAC has long been recognized.While long-standing DM is thought to be an etiologic factor for pancreatic cancer, new-onsetDM may be a manifestation of the cancer
115.8 ± 34.8 units, p < 0.05), new onset diabetes mellitus within 3 years (12/51 (23.5%) vs. 17/181 (9.8%), p < 0.05), carbohydrate antigen 19-9 level (609.5 ± 2342.5 vs. 17.0 ± 26.2, p = 0.08), main pancreatic duct dilatation (26/51 (51.0%) vs. 57/181 (31.5%), p < 0.05) in computed tomography scan were higher in pancreatic cancer group than in normal group, respectively
PDAC group and the normal group were compared for clinical characteristics and computed tomography (CT) scan findings (Table 1)
Summary
Pancreatic ductal adenocarcinoma (PDAC) has a low incidence but is frequently fatal. The dismal prognosis is mainly because 80–90% of patients have unresectable disease at the time of disease diagnosis [1]. DM or hyperglycemia, which frequently manifests as early as 2–3 years before a diagnosis of pancreatic cancer [2]. Patients with new-onset DM have 5- to 8-fold increased risk of being diagnosed with pancreatic cancer within 1–3 years of developing diabetes. The prevalence of DM in pancreatic cancer patients was reported to be 40%, and half of the DM patients with pancreatic cancer had new-onset DM with a duration of 2 years or less [3]. Previous reports demonstrated that the presence of focal hypo-attenuation and pancreatic duct dilatation on pre-diagnostic computed tomography (CT) scans are useful findings for the early diagnosis of pancreatic cancer. We tried to find out useful clinical clues of pre-radiologic and pre-symptomatic area prior to pancreatic cancer diagnosis patients compared to normal controls
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