Kleeff Jörg, Costello Eithne, Jackson Richard, Halloran Chris, Greenhalf William, Ghaneh Paula, Lamb Richard F, Lerch Markus M, Mayerle Julia, Palmer Daniel, Cox Trevor, Rawcliffe Charlotte L, Strobel Oliver, Büchler Markus W, Neoptolemos John P
Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.
NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
Br J Cancer. 2016 Sep 27;115(7):887-94. doi: 10.1038/bjc.2016.277. Epub 2016 Sep 1.
Diabetes mellitus is frequently observed in pancreatic cancer patients and is both a risk factor and an early manifestation of the disease.
We analysed the prognostic impact of diabetes on the outcome of pancreatic cancer following resection and adjuvant chemotherapy using individual patient data from three European Study Group for Pancreatic Cancer randomised controlled trials. Analyses were carried out to assess the association between clinical characteristics and the presence of preoperative diabetes, as well as the effect of diabetic status on overall survival.
In total, 1105 patients were included in the analysis, of whom 257 (23%) had confirmed diabetes and 848 (77%) did not. Median (95% confidence interval (CI)) unadjusted overall survival in non-diabetic patients was 22.3 (20.8-24.1) months compared with 18.8 (16.9-22.1) months for diabetic patients (P=0.24). Diabetic patients were older, had increased weight and more co-morbidities. Following adjustment, multivariable analysis demonstrated that diabetic patients had an increased risk of death (hazard ratio: 1.19 (95% CI 1.01, 1.40), P=0.034). Maximum tumour size of diabetic patients was larger at randomisation (33.6 vs 29.7 mm, P=0.026).
Diabetes mellitus was associated with increased tumour size and reduced survival following pancreatic cancer resection and adjuvant chemotherapy.
糖尿病在胰腺癌患者中很常见，既是该疾病的危险因素，也是其早期表现。
我们使用来自三项欧洲胰腺癌研究组随机对照试验的个体患者数据，分析了糖尿病对胰腺癌切除术后及辅助化疗结局的预后影响。进行分析以评估临床特征与术前糖尿病存在之间的关联，以及糖尿病状态对总生存期的影响。
总共1105例患者纳入分析，其中257例（23%）确诊患有糖尿病，848例（77%）未患糖尿病。非糖尿病患者未调整的中位总生存期（95%置信区间[CI]）为22.3（20.8 - 24.1）个月，而糖尿病患者为18.8（16.9 - 22.1）个月（P = 0.24）。糖尿病患者年龄更大，体重增加且合并症更多。调整后，多变量分析表明糖尿病患者死亡风险增加（风险比：1.19[95% CI 1.01, 1.40]，P = 0.034）。糖尿病患者随机分组时的最大肿瘤尺寸更大（33.6对29.7毫米，P = 0.026）。
糖尿病与胰腺癌切除术后及辅助化疗后肿瘤尺寸增大和生存期缩短相关。
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