Wang Furong, Gupta Samir, Holly Elizabeth A
Department of Epidemiology and Biostatistics, University of California San Francisco, Suite 280, 3333 California Street, San Francisco, CA 94118-1944, USA.
Cancer Epidemiol Biomarkers Prev. 2006 Aug;15(8):1458-63. doi: 10.1158/1055-9965.EPI-06-0188.
Diabetes has been postulated to be both a risk factor and a consequence of pancreatic cancer, but the degree of risk and associated clinical factors remain unclear.
We conducted a population-based case-control study of pancreatic cancer in the San Francisco Bay Area between 1995 and 1999. Rapid case ascertainment through the Surveillance, Epidemiology and End Results registry for cases and random selection from the general population for controls were employed to identify study participants with no proxy interviews.
Five hundred thirty-two cases and 1,701 controls were interviewed. Participants with pancreatic cancer were more likely to report a history of diabetes (13%) than were controls [9%; odds ratio (OR), 1.5; 95% confidence interval (95% CI), 1.1-2.1]. Compared with diabetics in the control group, diabetics in the case group had a shorter duration of diabetes (P = 0.0003) and a larger proportion of insulin users (P = 0.002). Risk for pancreatic cancer varied with duration of diabetes (OR, 2.4; 95% CI, 1.4-4.0 for 1-4 years; OR, 2.0; 95% CI, 1.2-3.4 for 5-9 years; and OR, 0.86; 95% CI, 0.52-1.4 for >or=10 years diabetes duration; P(trend) = 0.004). Among diabetics, use of oral diabetes medication or insulin for >or=5 years was not associated with pancreatic cancer, but insulin use of <5 years was associated with a 6.8-fold risk for pancreatic cancer (95% CI, 3.7-12).
Recent-onset diabetes may be a complication or an early marker of pancreatic cancer. Diabetes of short duration with insulin use conferred a substantially elevated risk for pancreatic cancer and may reflect insulin resistance that is elicited by pancreatic cancer.
糖尿病被认为既是胰腺癌的危险因素，也是其结果，但风险程度及相关临床因素仍不明确。
我们于1995年至1999年在旧金山湾区开展了一项基于人群的胰腺癌病例对照研究。通过监测、流行病学和最终结果登记处快速确定病例，并从一般人群中随机选择对照，以识别无需代理访谈的研究参与者。
共访谈了532例病例和1701名对照。胰腺癌患者报告有糖尿病病史的比例（13%）高于对照组[9%；优势比（OR）为1.5；95%置信区间（95%CI）为1.1 - 2.1]。与对照组中的糖尿病患者相比，病例组中的糖尿病患者糖尿病病程较短（P = 0.0003），且胰岛素使用者比例较高（P = 0.002）。胰腺癌风险随糖尿病病程而异（糖尿病病程1 - 4年时，OR为2.4；95%CI为1.4 - 4.0；糖尿病病程5 - 9年时，OR为2.0；95%CI为1.2 - 3.4；糖尿病病程≥10年时，OR为0.86；95%CI为0.52 - 1.4；P（趋势） = 0.004）。在糖尿病患者中，使用口服降糖药或胰岛素≥5年与胰腺癌无关，但胰岛素使用<5年与胰腺癌风险增加6.8倍相关（95%CI为3.7 - 12）。
近期发病的糖尿病可能是胰腺癌的并发症或早期标志物。短病程糖尿病伴胰岛素使用会使胰腺癌风险大幅升高，可能反映了胰腺癌引发的胰岛素抵抗。
