Chao David T, Shah Nilesh H, Zeh Herbert J, Bahary Nathan, Whitcomb David C, Brand Randall E
From the *Department of Internal Medicine, University of Pittsburgh Medical Center, Shadyside; and Division of †Gastroenterology, ‡Division of Gastrointestinal Surgical Oncology, Department of Surgery, and §Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Pancreas. 2016 Feb;45(2):228-33. doi: 10.1097/MPA.0000000000000439.
In considering whether medications that increase insulin levels accelerate pancreatic adenocarcinoma (PC) development, we hypothesized that PC patients with diabetes mellitus (DM) who used exogenous insulin or insulin-stimulating medications should have an earlier age at diagnosis or present with more advanced disease.
Patients enrolled in our PC registry from June 1, 2003, to May 31, 2012, were stratified according to treatment solely with insulin, insulin-stimulating medications, or insulin-independent medications. Age at PC diagnosis, PC stage, and years between DM and PC diagnoses were analyzed among the cohorts.
Of 122 DM patients (mean age, 67.4 ± 10.2 years), the mean ages at PC diagnosis within the insulin-only (n = 40), insulin-stimulating (n = 11), insulin-independent (n = 71), and non-DM (n = 321) cohorts were 68.7 ± 10.5, 69.6 ± 10.8, 66.3 ± 9.7, and 65.5 ± 10.5 years, respectively. No significant difference among the age at PC diagnosis was observed based on duration or type of DM treatment. There was no correlation between PC stage and increased insulin exposure.
Anti-DM medications that increase exposure to insulin do not appear to accelerate PC development using outcomes of mean age at PC diagnosis, PC stage, or duration between DM and PC diagnoses.
在考虑增加胰岛素水平的药物是否会加速胰腺腺癌（PC）发展时，我们假设使用外源性胰岛素或胰岛素刺激药物的糖尿病（DM）PC患者应在更早的年龄被诊断，或表现为病情更严重。
2003年6月1日至2012年5月31日纳入我们PC登记处的患者，根据仅使用胰岛素、胰岛素刺激药物或非胰岛素依赖药物进行分层。分析各队列中PC诊断时的年龄、PC分期以及DM和PC诊断之间的时间间隔。
在122例DM患者（平均年龄67.4±10.2岁）中，仅使用胰岛素（n = 40）、胰岛素刺激药物（n = 11）、非胰岛素依赖药物（n = 71）和非DM（n = 321）队列中PC诊断时的平均年龄分别为68.7±10.5、69.6±10.8、66.3±9.7和65.5±10.5岁。基于DM治疗的持续时间或类型，未观察到PC诊断时年龄的显著差异。PC分期与胰岛素暴露增加之间无相关性。
使用PC诊断时的平均年龄、PC分期或DM与PC诊断之间的持续时间等结果来看，增加胰岛素暴露量来治疗DM的药物似乎不会加速PC的发展。
