Abstract
AimTo investigate the effect of diabetes mellitus (DM) on disease-free and overall post-resection survival of patients with pancreatic ductal adenocarcinoma (PDAC)MethodsProspective observational study on patients admitted for pancreatic disease from January 2008 to October 2012. DM was classified as recent-onset (<48 months before PDAC diagnosis), longstanding (≥48 months before PDAC) or new onset (after surgery).ResultsOf 296 patients, 140 had a diagnosis of DM prior to surgery (26 longstanding, 99 recent-onset, 15 with unknown duration). Median follow-up time was 5.4 ± 0.22 years. Patients with recent onset DM had poorer postoperative survival than patients without DM: disease-free survival and overall survival were 1.14±0.13 years and 1.52±0.12 years in recent onset DM, versus 1.3±0.15 years and 1.87±0.15 years in non-diabetic patients (p = 0.013 and p = 0.025, respectively). Longstanding DM and postoperative new onset DM had no impact on prognosis. Compared to cases without DM, patients with recent onset DM were more likely to have residual disease after surgery and to develop liver metastases during follow-up. Multivariate analysis confirmed recent onset DM was independently associated with PDAC relapse (hazard ratio 1.45 [1.06–1.99]).ConclusionPreoperative recent onset DM has an impact on survival after the resection of PDAC.
Highlights
The association between pancreatic ductal carcinoma (PDAC) and diabetes mellitus (DM) is complex [1,2,3] and numerous epidemiological studies have examined this relationship [4,5,6,7,8]
Longstanding DM and postoperative new onset DM had no impact on prognosis
Multivariate analysis confirmed recent onset DM was independently associated with PDAC relapse
Summary
The association between pancreatic ductal carcinoma (PDAC) and diabetes mellitus (DM) is complex [1,2,3] and numerous epidemiological studies have examined this relationship [4,5,6,7,8]. We recently conducted a prospective observational study to describe the clinical features, risk factors and etiopathogenetic aspects of patients with DM associated with pancreas disease (T3cDM) [30, 31]. This cohort allows us to analyse a population with PDAC (among the 651 recruits 364 had a diagnosis of PDAC), with the advantage of having: (i) clinical and biochemical data collected according to a standard protocol (prospective design); (ii) diabetes diagnosis based on fasting glucose or glycosylated hemoglobin instead of proxy or self-reported information; (iii) information on insulin secretion and sensitivity and/or islet autoimmunity; and (iv) planned follow-up. Given the different pathophysiology we evaluated the association of DM with patient survival in patients with PDAC separately for long-standing DM, recent-onset DM and post resection DM
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