Yuan Chen, Rubinson Douglas A, Qian Zhi Rong, Wu Chen, Kraft Peter, Bao Ying, Ogino Shuji, Ng Kimmie, Clancy Thomas E, Swanson Richard S, Gorman Megan J, Brais Lauren K, Li Tingting, Stampfer Meir J, Hu Frank B, Giovannucci Edward L, Kulke Matthew H, Fuchs Charles S, Wolpin Brian M
Chen Yuan, Douglas A. Rubinson, Zhi Rong Qian, Shuji Ogino, Kimmie Ng, Megan J. Gorman, Lauren K. Brais, Tingting Li, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute; Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, Frank B. Hu, and Edward L. Giovannucci, Harvard School of Public Health; and Ying Bao, Shuji Ogino, Kimmie Ng, Thomas E. Clancy, Richard S. Swanson, Meir J. Stampfer, Frank B. Hu, Edward L. Giovannucci, Matthew H. Kulke, Charles S. Fuchs, and Brian M. Wolpin, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
J Clin Oncol. 2015 Jan 1;33(1):29-35. doi: 10.1200/JCO.2014.57.5688. Epub 2014 Nov 17.
Long-standing diabetes is a risk factor for pancreatic cancer, and recent-onset diabetes in the several years before diagnosis is a consequence of subclinical pancreatic malignancy. However, the impact of diabetes on survival is largely unknown.
We analyzed survival by diabetes status among 1,006 patients diagnosed from 1986 to 2010 from two prospective cohort studies: the Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). We validated our results among 386 patients diagnosed from 2004 to 2013 from a clinic-based case series at Dana-Farber Cancer Institute (DFCI). We estimated hazard ratios (HRs) for death using Cox proportional hazards models, with adjustment for age, sex, race/ethnicity, smoking, diagnosis year, and cancer stage.
In NHS and HPFS, HR for death was 1.40 (95% CI, 1.15 to 1.69) for patients with long-term diabetes (> 4 years) compared with those without diabetes (P < .001), with median survival times of 3 months for long-term diabetics and 5 months for nondiabetics. Adjustment for a propensity score to reduce confounding by comorbidities did not change the results. Among DFCI patient cases, HR for death was 1.53 (95% CI, 1.07 to 2.20) for those with long-term diabetes compared with those without diabetes (P = .02), with median survival times of 9 months for long-term diabetics and 13 months for nondiabetics. Compared with nondiabetics, survival times were shorter for long-term diabetics who used oral hypoglycemics or insulin. We observed no statistically significant association of recent-onset diabetes (< 4 years) with survival.
Long-standing diabetes was associated with statistically significantly decreased survival among patients with pancreatic cancer enrolled onto three longitudinal studies.
长期糖尿病是胰腺癌的一个危险因素，而诊断前数年新发生的糖尿病是亚临床胰腺恶性肿瘤的一个后果。然而，糖尿病对生存率的影响很大程度上尚不清楚。
我们通过糖尿病状态分析了1986年至2010年期间从两项前瞻性队列研究（护士健康研究[ NHS ]和卫生专业人员随访研究[ HPFS ]）中确诊的1006例患者的生存率。我们在达纳 - 法伯癌症研究所（DFCI）基于临床病例系列的386例2004年至2013年确诊的患者中验证了我们的结果。我们使用Cox比例风险模型估计死亡风险比（HRs），并对年龄、性别、种族/族裔、吸烟、诊断年份和癌症分期进行了调整。
在NHS和HPFS中，与无糖尿病患者相比，长期糖尿病患者（> 4年）的死亡HR为1.40（95%CI，1.15至1.69）（P <.001），长期糖尿病患者的中位生存时间为3个月，非糖尿病患者为5个月。通过倾向评分调整以减少合并症的混杂作用并没有改变结果。在DFCI患者病例中，与无糖尿病患者相比，长期糖尿病患者的死亡HR为1.53（95%CI，1.07至2.20）（P =.02），长期糖尿病患者的中位生存时间为9个月，非糖尿病患者为13个月。与非糖尿病患者相比，使用口服降糖药或胰岛素的长期糖尿病患者的生存时间更短。我们观察到新发生的糖尿病（< 4年）与生存率之间无统计学显著关联。
在三项纵向研究中纳入的胰腺癌患者中，长期糖尿病与统计学上显著降低的生存率相关。
