Division of Gastroenterology and Hepatology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan.
Endocr Pract. 2020 Jul;26(7):707-713. doi: 10.4158/EP-2019-0565. Epub 2020 Nov 24.
Diabetes mellitus (DM) is a risk factor for pancreatic cancer but its prognostic impact remains controversial. We aimed to investigate the association between long-standing DM and the risk of mortality.
This population-based cohort study analyzed data from the national healthcare database in Taiwan. We identified all patients diagnosed with pancreatic cancer and excluded those who were diagnosed with DM with-in 2 years of the cancer diagnosis. Eligible patients were grouped into long-standing DM (>2 years) and nondiabetic controls, and were compared for overall survival using a Cox proportional hazard model. Sensitivity tests stratified by cancer stages (as indicated by specific treatment) were performed.
Patients with long-standing DM were significantly older (mean age, 71.38 years versus 66.0 years; P<.0001) and had a higher Charlson comorbidity index (9.53 versus 6.78; P<.0001) and diabetes comorbidity severity index (2.38 versus 0.82; P<.0001) compared with the non-DM controls. Although the unadjusted analysis showed a higher risk of mortality in the patients with long-term DM (crude hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.20 to 1.33; P<.0001), the association became insignificant after adjustment for age, sex, and comorbidity index (adjusted HR, 1.01; 95% CI, 0.95 to 1.06, P = .84). Subgroup analyses also showed no association between long-term DM and mortality in various subgroups stratified by cancer treatment.
After adjusting for associated comorbidities and complications, long-standing DM per se was not an independent prognostic factor for overall survival in this nationwide population-based cohort with pancreatic cancer.
CCI = Charlson Comorbidity Index; CI = confidence interval; DCSI = Diabetes Complication Severity Index; DM = diabetes mellitus; HR = hazard ratio; ICD = International Classification of Diseases; NHIRD = National Health Insurance Research Database; RCIPD = Registry for Catastrophic Illness Patient Database.
糖尿病（DM）是胰腺癌的一个危险因素，但它的预后影响仍存在争议。本研究旨在探讨长期 DM 与死亡率之间的关系。
这是一项基于人群的队列研究，分析了来自台湾国家医疗保健数据库的数据。我们纳入了所有诊断为胰腺癌的患者，并排除了在癌症诊断后 2 年内被诊断为 DM 的患者。符合条件的患者被分为长期 DM（>2 年）和非糖尿病对照组，并使用 Cox 比例风险模型比较总体生存率。根据癌症分期（由特定治疗指示）进行了敏感性测试。
长期 DM 组患者的年龄明显较大（平均年龄 71.38 岁比 66.0 岁；P＜0.0001），Charlson 合并症指数（9.53 比 6.78；P＜0.0001）和糖尿病合并症严重程度指数（2.38 比 0.82；P＜0.0001）较高。虽然未调整分析显示长期 DM 患者的死亡率风险较高（未调整危险比 [HR]，1.26；95%置信区间 [CI]，1.20 至 1.33；P＜0.0001），但调整年龄、性别和合并症指数后，该关联变得不显著（调整 HR，1.01；95%CI，0.95 至 1.06，P=0.84）。亚组分析还显示，在按癌症治疗分层的各种亚组中，长期 DM 与死亡率之间没有关联。
在调整相关合并症和并发症后，长期 DM 本身并不是该全国性基于人群的胰腺癌队列中总体生存的独立预后因素。
