Lund University and Skåne University Hospital, Department of Clinical Sciences Lund, Division of Surgery, Lund, Sweden; Lund University and Skåne University Hospital, Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund, Sweden.
Skåne Regional Laboratories, Department of Pathology, Lund, Sweden.
Pancreatology. 2018 Jan;18(1):85-93. doi: 10.1016/j.pan.2017.11.003. Epub 2017 Nov 11.
The life expectancy of pancreatic cancer patients remains minimal. The disease progression may be influenced by type 2 diabetes (T2D) and inflammatory status, although important gaps persist around their joint effects on disease outcome. The aim of this study was to investigate the clinical significance of the tumour immune microenvironment on pancreatic cancer prognosis in relation to T2D status.
Tumour-infiltrating macrophages, neutrophils and eosinophils were studied in primary pancreatic tumours and paired lymph node metastases in relation to patient and tumour characteristics, T2D status and overall survival in a retrospective cohort of patients with resectable pancreatic cancer in Sweden.
Of the 80 included pancreatic cancer patients, 22 (27.2%) had T2D. The diabetic pancreatic cancer patients had significantly higher systemic high white blood cell count than those without diabetes (P = 0.028). Macrophage infiltration levels were higher in lymph node metastases compared with primary tumours (P = 0.040) among pancreatic cancer patients with diabetes. Type 2 diabetes or intra-tumoural leukocyte (macrophage, neutrophil or eosinophil) infiltration alone did not significantly influence pancreatic cancer prognosis. However, among cancer patients with T2D high macrophage or neutrophil tumour-infiltration was associated with a significant reduction in overall survival (adjusted hazard ratio [HR] 7.2; 95% CI 1.5-35.0 and HR 5.4; 95% CI 1.1-26.3, respectively).
These results demonstrate associations between T2D and enhanced inflammatory processes with significant implications on survival among pancreatic cancer patients with T2D. Validation in larger independent patient cohorts may identify additional prognostic tools and improved treatment strategies for specific patient subsets.
胰腺癌患者的预期寿命仍然很短。疾病的进展可能受到 2 型糖尿病（T2D）和炎症状态的影响，尽管它们对疾病结局的共同影响仍存在重要差距。本研究旨在探讨肿瘤免疫微环境与 T2D 状态对胰腺癌预后的临床意义。
在瑞典一个可切除胰腺癌患者的回顾性队列中，研究了原发性胰腺肿瘤和配对淋巴结转移中浸润的肿瘤巨噬细胞、中性粒细胞和嗜酸性粒细胞与患者和肿瘤特征、T2D 状态以及总生存的关系。
在 80 名纳入的胰腺癌患者中，22 名（27.2%）患有 T2D。糖尿病胰腺癌患者的全身高白细胞计数明显高于无糖尿病患者（P=0.028）。在患有糖尿病的胰腺癌患者中，淋巴结转移中的巨噬细胞浸润水平高于原发性肿瘤（P=0.040）。单独的 T2D 或肿瘤内白细胞（巨噬细胞、中性粒细胞或嗜酸性粒细胞）浸润并不能显著影响胰腺癌的预后。然而，在患有 T2D 的癌症患者中，高肿瘤巨噬细胞或中性粒细胞浸润与总生存期显著缩短相关（调整后的危险比[HR]7.2；95%CI1.5-35.0 和 HR5.4；95%CI1.1-26.3）。
这些结果表明 T2D 与增强的炎症过程之间存在关联，并对患有 T2D 的胰腺癌患者的生存产生重大影响。在更大的独立患者队列中进行验证可能会确定其他预后工具和针对特定患者亚组的改进治疗策略。
