Pergolini Ilaria, Jäger Carsten, Safak Okan, Göß Rüdiger, Novotny Alexander, Ceyhan Güralp O, Friess Helmut, Demir Ihsan Ekin
Department of Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Clin Gastroenterol Hepatol. 2021 Jan;19(1):171-179. doi: 10.1016/j.cgh.2020.04.090. Epub 2020 May 11.
BACKGROUND & AIMS: The role of diabetes in intraductal papillary mucinous neoplasms (IPMNs) is not known. We investigated the prevalence of diabetes among patients with resected IPMNs and the association between diabetes, clinical and morphological features, and high-grade dysplasia or invasive cancer.
We collected clinical, pathology, laboratory, and demographic data from 134 patients who underwent pancreatic resection for IPMN from a referral center in Germany. We identified 50 patients with diabetes (37%).
Higher proportions of patients with diabetes were male and older, but did not have increased body mass index, compared to patients without diabetes. Diabetes was significantly associated with main-duct involvement (odds ratio [OR], 2.827; 95% CI, 1.059-7.546; P = .038) and high-grade dysplasia or invasive carcinoma (OR, 2.692; 95% CI, 1.283-5.651; P = .009). Risk of high-grade dysplasia or invasive cancer was even higher in patients with new-onset or worsening diabetes (OR, 4.615; 95% CI, 1.423-14.698; P = .011). Fifty-eight percent of patients (18/31) with weight loss at diagnosis had diabetes vs 32% of patients (31/97) without weight loss (P = .009). However, when the analysis was restricted to IPMNs with low-grade dysplasia, weight loss and diabetes were no longer associated (42% [5/12] vs 21% [9/44]; P = .133).
In patients with IPMNs, diabetes is associated with increased risk of main duct involvement and high-grade dysplasia or invasive carcinoma. Studies are needed to determine the relationship between diabetes and progression of IPMNs, which might lead to strategies for early detection and prevention of invasive cancer. Findings from this study should be considered in the guidelines for management of IPMN.
糖尿病在导管内乳头状黏液性肿瘤（IPMNs）中的作用尚不清楚。我们调查了接受IPMNs切除术患者中糖尿病的患病率，以及糖尿病、临床和形态学特征与高级别异型增生或浸润性癌之间的关联。
我们从德国一家转诊中心收集了134例因IPMNs接受胰腺切除术患者的临床、病理、实验室和人口统计学数据。我们确定了50例糖尿病患者（37%）。
与非糖尿病患者相比，糖尿病患者中男性和年龄较大者的比例更高，但体重指数没有增加。糖尿病与主胰管受累显著相关（比值比[OR]，2.827；95%置信区间，1.059 - 7.546；P = 0.038）以及高级别异型增生或浸润性癌（OR，2.692；95%置信区间，1.283 - 5.651；P = 0.009）。新发或病情恶化的糖尿病患者发生高级别异型增生或浸润性癌的风险甚至更高（OR，4.615；95%置信区间，1.423 - 14.698；P = 0.011）。诊断时体重减轻的患者中有58%（18/31）患有糖尿病，而体重未减轻的患者中这一比例为32%（31/97）（P = 0.009）。然而，当分析仅限于低级别异型增生的IPMNs时，体重减轻与糖尿病不再相关（42%[5/12]对21%[9/44]；P = 0.133）。
在IPMNs患者中，糖尿病与主胰管受累以及高级别异型增生或浸润性癌的风险增加相关。需要开展研究以确定糖尿病与IPMNs进展之间的关系，这可能会带来早期检测和预防浸润性癌的策略。本研究结果应在IPMNs管理指南中予以考虑。
