Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Sci Rep. 2021 Dec 7;11(1):23538. doi: 10.1038/s41598-021-02858-z.
This study investigated the correlation between pancreatic fibrosis (PF) and development of pancreoprivic diabetes after pancreaticoduodenectomy (PD). Ninety-five patients who underwent PD at Gangnam Severance Hospital between 2014 and 2017 were enrolled. PF grade was evaluated with alpha-smooth muscle actin (SMA) and Masson's trichrome (TRC) staining. New-onset pancreoprivic diabetes and recurrence of disease were evaluated using fasting blood glucose measurement and radiography taken at 3-month intervals. Sixty-one patients did not have preoperative diabetes, however, 40 (65.6%) patients developed pancreoprivic diabetes after PD. High-grade PF was more common in the diabetes group than in the normal group (SMA, 42.5% vs. 28.6%, P = 0.747; TRC, 47.5% vs. 28.6%, P = 0.361). The 1-year cumulative incidence of hyperglycemia/pancreoprivic diabetes was higher with high-grade PF than low-grade PF (SMA, 94.4% vs. 73.0%, P = 0.027; TRC, 89.3% vs. 75.0%, P = 0.074). The SMA-TRC combined high-grade group had a higher proportion of primary pancreatic disease than the combined low-grade group (90.0% vs. 37.5%, P = 0.001). The 5-year disease-free survival of patients with pancreatic cancer was worse with high-grade PF than low-grade PF (SMA, 24.5% vs. 66.3%, P = 0.026; TRC, 23.6% vs. 58.4%, P = 0.047). In conclusion, patients with severe PF are more likely to develop pancreoprivic diabetes after PD and have worse disease-free survival.
本研究旨在探讨胰腺纤维化（PF）与胰十二指肠切除术后（PD）发生胰性糖尿病之间的相关性。本研究纳入了 2014 年至 2017 年在江南塞弗伦斯医院接受 PD 的 95 例患者。采用α-平滑肌肌动蛋白（SMA）和 Masson 三色（TRC）染色评估 PF 分级。通过空腹血糖测量和每 3 个月拍摄的影像学评估新发胰性糖尿病和疾病复发情况。61 例患者术前无糖尿病，但 40 例（65.6%）患者在 PD 后发生胰性糖尿病。高等级 PF 在糖尿病组中更为常见，高于正常组（SMA：42.5%比 28.6%，P=0.747；TRC：47.5%比 28.6%，P=0.361）。高等级 PF 的 1 年累积高血糖/胰性糖尿病发生率高于低等级 PF（SMA：94.4%比 73.0%，P=0.027；TRC：89.3%比 75.0%，P=0.074）。SMA-TRC 联合高等级组的原发性胰腺疾病比例高于联合低等级组（90.0%比 37.5%，P=0.001）。高等级 PF 的胰腺癌患者 5 年无病生存率低于低等级 PF（SMA：24.5%比 66.3%，P=0.026；TRC：23.6%比 58.4%，P=0.047）。总之，PF 严重的患者在 PD 后更有可能发生胰性糖尿病，并且无病生存率更差。
