Ogawa Yoshiaki, Tanaka Masao, Inoue Ken, Yamaguchi Koji, Chijiiwa Kazuo, Mizumoto Kazuhiro, Tsutsu Nobutaka, Nakamura Yoshihiro
Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
Cancer. 2002 May 1;94(9):2344-9. doi: 10.1002/cncr.10493.
The correlation between diabetes mellitus and pancreatic carcinoma is well documented, but no criteria have been established for the efficient selection of a high-risk group among patients with diabetes mellitus.
Eighty-seven patients were selected prospectively from outpatients with diabetes and underwent endoscopic retrograde pancreatography (ERP) according to the authors' original criteria, including the onset of diabetes after age 55 years, deterioration of diabetes or loss of body weight despite strict medical control, elevation of serum amylase and/or CA19-9 levels, and pancreatobiliary abnormalities on routine ultrasonography. The patients were divided into two groups according to the time from the onset of diabetes to ERP: Patients in Group A had recent-onset diabetes (within 3 years), and Group B patients had diabetes for > 3 years.
A total of 86 patients (excluding 1 patient with unsuccessful ERP who had undergone previous Billroth-2 gastrectomy) were enrolled. There were 33 males and 53 females, age 40-90 years, with a mean age of 65.1 years. ERP demonstrated pancreatic carcinoma, although it was advanced disease in all patients, at an extremely high rate of 7.0% (6 of 86 patients) with no serious complications. The prevalence of pancreatic carcinoma in Group A (13.9%; 5 of 36 patients) was significantly greater compared with Group B (2.0%; 1 of 50 patients; P = 0.0442). ERP with an indwelling balloon catheter and subsequent pancreatic juice sampling was performed in 49 patients, yielding positive cytology in 1 patient with pancreatic tail carcinoma, whereas measurements of carcinoembryonic antigen and CA19-9 levels in pancreatic juice were of no use in the diagnosis of pancreatic carcinoma.
Selective ERP in patients with diabetes who were at high risk did not lead to the early diagnosis of pancreatic carcinoma, although this study showed that the 3-year period after the onset of diabetes was critical. A more aggressive diagnostic approach within this period in diabetic patients with the authors' criteria may contribute to the earlier diagnosis of pancreatic carcinoma.
糖尿病与胰腺癌之间的相关性已有充分记载，但尚未建立在糖尿病患者中有效筛选高危人群的标准。
前瞻性地从糖尿病门诊患者中选取87例患者，根据作者原有的标准进行内镜逆行胰胆管造影（ERP），这些标准包括55岁后发病的糖尿病、尽管严格药物控制但糖尿病病情恶化或体重减轻、血清淀粉酶和/或CA19-9水平升高以及常规超声检查发现胰胆管异常。根据从糖尿病发病到ERP的时间将患者分为两组：A组患者为近期发病的糖尿病（3年内），B组患者糖尿病病程>3年。
共纳入86例患者（排除1例既往接受毕Ⅱ式胃切除术且ERP未成功的患者）。其中男性33例，女性53例，年龄40 - 90岁，平均年龄65.1岁。ERP显示为胰腺癌，尽管所有患者均为进展期疾病，但胰腺癌的检出率极高，为7.0%（86例患者中的6例），且无严重并发症。A组胰腺癌患病率（13.9%；36例患者中的5例）显著高于B组（2.0%；50例患者中的1例；P = 0.0442）。49例患者进行了带气囊导管留置的ERP及后续胰液采样，1例胰尾癌患者胰液细胞学检查呈阳性，而胰液中癌胚抗原和CA19-9水平测定对胰腺癌诊断无用。
高危糖尿病患者的选择性ERP未能实现胰腺癌的早期诊断，尽管本研究表明糖尿病发病后的3年时间至关重要。在此期间，对符合作者标准的糖尿病患者采用更积极的诊断方法可能有助于胰腺癌的早期诊断。
