术前糖尿病及高血糖程度对切除的胰腺导管腺癌预后的相关性

Prognostic relevance of preoperative diabetes mellitus and the degree of hyperglycemia on the outcomes of resected pancreatic ductal adenocarcinoma.

作者信息

Lee Woohyung, Yoon Yoo-Seok, Han Ho-Seong, Cho Jai Young, Choi YoungRok, Jang Jae Yool, Choi Hanlim

机构信息

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.

出版信息

J Surg Oncol. 2016 Feb;113(2):203-8. doi: 10.1002/jso.24133.

DOI:10.1002/jso.24133

PMID:26799261

Abstract

INTRODUCTION

The prognostic relevance of preoperative diabetes mellitus (DM) on the outcomes of resected pancreatic ductal adenocarcinoma (PDAC) is controversial. Most previous studies evaluated the prognostic role of DM based on a single blood test.

METHODS

The participants included 147 patients with PDAC who underwent pancreatectomy between September 2003 and June 2012. They were divided into following groups according to the preoperative DM and degree of hyperglycemia defined by glycosylated hemoglobin (HbA1c): non-DM (n = 70), DM with HbA1c < 9.0% (n = 52), and DM with HbA1c ≥ 9.0% (n = 25).

RESULTS

There were no significant differences in cancer stage or postoperative complications among the three groups. The survival rate was significantly lower in the DM with HbA1c ≥ 9.0% group (22.3%) than in the non-DM group (33.6%) and the DM with HbA1c < 9.0% group (33.8%) (P = 0.044). Multivariate analysis revealed that DM with HbA1c ≥ 9.0% (hazard ratio [HR] 2.495, 95% confidence interval [CI] 1.274-4.886, P = 0.008) and the presence of venous invasion (HR 1.836, 95%CI 1.072-3.146, P = 0.027) were independent prognostic factors for survival.

CONCLUSION

Uncontrolled severe hyperglycemia rather than preoperative DM negatively affects the survival outcomes following PDAC resection.

摘要

引言

术前糖尿病（DM）对切除的胰腺导管腺癌（PDAC）预后的相关性存在争议。大多数先前的研究基于单次血液检测评估DM的预后作用。

方法

参与者包括2003年9月至2012年6月期间接受胰腺切除术的147例PDAC患者。根据术前DM和糖化血红蛋白（HbA1c）定义的高血糖程度将他们分为以下几组：非DM组（n = 70）、HbA1c < 9.0%的DM组（n = 52）和HbA1c≥9.0%的DM组（n = 25）。

结果

三组之间在癌症分期或术后并发症方面无显著差异。HbA1c≥9.0%的DM组生存率（22.3%）显著低于非DM组（33.6%）和HbA1c < 9.0%的DM组（33.8%）（P = 0.044）。多变量分析显示，HbA1c≥9.0%的DM（风险比[HR] 2.495，95%置信区间[CI] 1.274 - 4.886，P = 0.008）和静脉侵犯的存在（HR 1.836，95%CI 1.072 - 3.146，P = 0.027）是生存的独立预后因素。