糖尿病是否会影响可手术切除胰腺癌的临床表现、分期及生存率？
Does diabetes mellitus affect presentation, stage and survival in operable pancreatic cancer?
作者信息
Chia Clement L K, Lee Anthea Y S, Shelat Vishal G, Ahmed Saleem, Junnarkar Sameer P, Woon Winston W L, Low Jee-Keem
机构信息
1 Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore ; 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
出版信息
Hepatobiliary Surg Nutr. 2016 Feb;5(1):38-42. doi: 10.3978/j.issn.2304-3881.2015.07.04.
BACKGROUND
The aim of the study is to investigate differences in clinical presentation, disease stage and survival of operable pancreatic cancer patients with new onset DM compared to long standing diabetes mellitus (DM) and non diabetics.
METHODS
A prospectively maintained pancreatic cancer surgery database of a tertiary care teaching hospital from January 2006 to August 2012 was reviewed. Only patients with a histological diagnosis of pancreatic carcinoma (PC) were included in final analysis. DM was defined as HbA1c >6.5% or any patient on anti-diabetic treatment regardless of HbA1c value. New onset DM was defined when diagnosed within two preceding years of surgery. Patients were stratified into two groups: DM and non DM. Among the DM patients, patients with new onset DM were further stratified and studied separately. Staging of PC was performed according to the 6(th) edition of AJCC. Survival of patients with PC was determined by reviewing medical records. Patients and their families were contacted if there was no existing follow-up.
RESULTS
Eighty-six patients (n=55, 63.9% male) with a mean age of 62 years (range, 29-85 years) underwent pancreatic cancer surgery during the study period. Of the 86 patients, 30 (34%) had DM of which eight patients (9% overall) had new onset DM. DM patients tended to be older compared to non DM patients (67.8 vs. 58.5 years, P=0.0005). The majority of non DM patients were symptomatic (98.2%), and there was a tendency for DM group patients to be asymptomatic at presentation (13.3% vs. 1.8%, P=0.05). Abdominal pain was less common in DM patients compared to non DM patients (30% vs. 53.6%, P=0.04). The median duration of new onset DM prior to diagnosis of PC was 2 months (range, 1-23 months). There was a tendency for DM patients to present at an early stage (stage I and stage II) (P=0.08). There was no difference in survival (P=0.17) for new onset DM compared to long standing DM and non DM patients.
CONCLUSIONS
DM patients tend to be older and are less likely to present with abdominal pain. Asymptomatic presentation and early stage disease tends to occur in DM patients. A larger sample size is required to determine if survival of new onset DM patients differs from long standing and non DM patients.
背景
本研究旨在调查新发糖尿病（DM）的可手术胰腺癌患者与长期糖尿病患者及非糖尿病患者在临床表现、疾病分期和生存率方面的差异。
方法
回顾了一家三级医疗教学医院2006年1月至2012年8月前瞻性维护的胰腺癌手术数据库。最终分析仅纳入经组织学诊断为胰腺癌（PC）的患者。DM定义为糖化血红蛋白（HbA1c）>6.5%或任何接受抗糖尿病治疗的患者，无论HbA1c值如何。新发DM定义为在手术前两年内确诊。患者被分为两组：DM组和非DM组。在DM患者中，新发DM患者进一步分层并单独研究。PC分期根据美国癌症联合委员会（AJCC）第6版进行。通过查阅病历确定PC患者的生存率。如果没有现有随访记录，则联系患者及其家属。
结果
在研究期间，86例患者（n = 55，63.9%为男性）接受了胰腺癌手术，平均年龄62岁（范围29 - 85岁）。在这86例患者中，30例（34%）患有DM，其中8例（占总数的9%）为新发DM。与非DM患者相比，DM患者年龄更大（67.8岁对58.5岁，P = 0.0005）。大多数非DM患者有症状（98.2%），而DM组患者在就诊时无症状的倾向（13.3%对1.8%，P = 0.05）。与非DM患者相比，DM患者腹痛较少见（30%对53.6%，P = 0.04）。在诊断PC之前，新发DM的中位持续时间为2个月（范围1 - 23个月）。DM患者有在早期阶段（I期和II期）就诊的倾向（P = 0.08）。新发DM患者与长期DM患者及非DM患者在生存率方面无差异（P = 0.17）。
结论
DM患者往往年龄更大，出现腹痛的可能性较小。DM患者倾向于无症状就诊且疾病处于早期阶段。需要更大的样本量来确定新发DM患者的生存率是否与长期DM患者及非DM患者不同。
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