Bures Jan, Kohoutova Darina, Skrha Jan, Bunganic Bohus, Ngo Ondrej, Suchanek Stepan, Skrha Pavel, Zavoral Miroslav
Institute of Gastrointestinal Oncology, Military University Hospital Prague, 169 02 Prague, Czech Republic.
Department of Medicine, First Faculty of Medicine, Charles University, Prague and Military University Hospital Prague, 169 02 Prague, Czech Republic.
Cancers (Basel). 2023 Jul 19;15(14):3669. doi: 10.3390/cancers15143669.
Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis, with near-identical incidence and mortality. According to the World Health Organization Globocan Database, the estimated number of new cases worldwide will rise by 70% between 2020 and 2040. There are no effective screening methods available so far, even for high-risk individuals. The prognosis of PDAC, even at its early stages, is still mostly unsatisfactory. Impaired glucose metabolism is present in about 3/4 of PDAC cases.
Available literature on pancreatic cancer and diabetes mellitus was reviewed using a PubMed database. Data from a national oncology registry (on PDAC) and information from a registry of healthcare providers (on diabetes mellitus and a number of abdominal ultrasound investigations) were obtained.
New-onset diabetes mellitus in subjects older than 60 years should be an incentive for a prompt and detailed investigation to exclude PDAC. Type 2 diabetes mellitus, diabetes mellitus associated with chronic non-malignant diseases of the exocrine pancreas, and PDAC-associated type 3c diabetes mellitus are the most frequent types. Proper differentiation of particular types of new-onset diabetes mellitus is a starting point for a population-based program. An algorithm for subsequent steps of the workup was proposed.
The structured, well-differentiated, and elaborately designed approach to the elderly with a new onset of diabetes mellitus could improve the current situation in diagnostics and subsequent poor outcomes of therapy of PDAC.
胰腺导管腺癌（PDAC）的预后很差，发病率和死亡率几乎相同。根据世界卫生组织全球癌症数据库，2020年至2040年间，全球新发病例估计将增加70%。到目前为止，即使对于高危个体，也没有有效的筛查方法。PDAC的预后，即使在早期阶段，大多仍不尽人意。约3/4的PDAC病例存在糖代谢受损。
使用PubMed数据库对有关胰腺癌和糖尿病的现有文献进行综述。获取了来自国家肿瘤登记处（关于PDAC）的数据以及来自医疗服务提供者登记处（关于糖尿病和多项腹部超声检查）的信息。
60岁以上人群新发糖尿病应促使进行迅速而详细的检查以排除PDAC。2型糖尿病、与外分泌胰腺慢性非恶性疾病相关的糖尿病以及与PDAC相关的3c型糖尿病是最常见的类型。正确区分特定类型的新发糖尿病是基于人群的项目的起点。提出了后续检查步骤的算法。
对新发糖尿病老年人采用结构化、区分明确且精心设计的方法，可能会改善目前PDAC诊断及后续治疗效果不佳的状况。
