Mohindroo Chirayu, Dy Paul S, Hande Suraj P, D'Adamo Christopher R, Mavanur Arun, Thomas Asha, McAllister Florencia, De Jesus-Acosta Ana
Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA.
Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Gastrointest Oncol. 2025 Feb 28;16(1):226-233. doi: 10.21037/jgo-24-570. Epub 2025 Feb 26.
One percent of pancreatic adenocarcinoma (PDAC) patients are diagnosed with new onset diabetes (NOD) over the age of 50 years within 3 years. Therefore, NOD is a major factor for early diagnosis of PDAC. Research has focused on understanding the differences between NOD and type 2 diabetes, particularly in relation to PDAC. However, conflicting data exists regarding their impact on survival outcomes in PDAC patients. We performed this multi-center study to assess the prevalence and influence of NOD on clinical outcomes in patients with PDAC within a community-based hospital system.
We conducted a retrospective cohort study of 138 patients with biopsy-proven PDAC with localized/borderline disease (n=70), and metastatic disease (n=68) at three institutions from 2014 to 2021. NOD group consisted of pts diagnosed with diabetes [hemoglobin A1c (HbA1c) >6.5%] or pre-diabetes (HbA1c 5.7-6.4%) within the 3 years prior to PDAC diagnosis. Primary aim of the study was to determine the impact of NOD on clinical outcomes.
A total of 138 patients were included in the study, from which 30 met the criteria for NOD. No significant differences were noted in the demographic and clinical characteristics comparing patients based on NOD history. Comparing survival outcomes, NOD group was associated with worse overall survival (OS) in both the metastatic cohort [n=68, progression-free survival (PFS) 4.6 . 7.1 months, P=0.07; OS 7.1 . 13.2 months, P=0.01) and the resected cohort (n=40, PFS 8.4 . 19.3 months, P=0.04; OS 24.5 . 42.3 months, P=0.04). In multivariate analysis, the impact of NOD remained significant for OS and PFS in the resected cohort. Identifying common features amongst the NOD group, we found the entire cohort had a significant reduction in individual body mass index (BMI) 1 year prior to the NOD diagnosis (P=0.006).
NOD is associated with worse survival outcomes in patients with metastatic and resected PDAC. Reduction of BMI prior to diagnosis of NOD, warrants further investigation to be incorporated into the PDAC screening paradigm.
1%的胰腺导管腺癌（PDAC）患者在50岁以上且在3年内被诊断为新发糖尿病（NOD）。因此，NOD是PDAC早期诊断的一个主要因素。研究主要集中在了解NOD与2型糖尿病之间的差异，特别是与PDAC相关的差异。然而，关于它们对PDAC患者生存结果的影响，存在相互矛盾的数据。我们进行了这项多中心研究，以评估NOD在社区医院系统内对PDAC患者临床结果的患病率和影响。
我们对2014年至2021年在三个机构中138例经活检证实为局部/边界性疾病（n = 70）和转移性疾病（n = 68）的PDAC患者进行了回顾性队列研究。NOD组由在PDAC诊断前3年内被诊断为糖尿病[糖化血红蛋白（HbA1c）>6.5%]或糖尿病前期（HbA1c 5.7 - 6.4%）的患者组成。该研究的主要目的是确定NOD对临床结果的影响。
共有138例患者纳入研究，其中30例符合NOD标准。根据NOD病史比较患者的人口统计学和临床特征，未发现显著差异。比较生存结果，NOD组在转移性队列[n = 68，无进展生存期（PFS）4.6对7.1个月，P = 0.07；总生存期（OS）7.1对13.2个月，P = 0.01]和切除队列[n = 40，PFS 8.4对19.3个月，P = 0.04；OS 24.5对42.3个月，P = 0.04]中均与较差的总生存期相关。在多变量分析中，NOD对切除队列的OS和PFS的影响仍然显著。在NOD组中识别共同特征时，我们发现整个队列在NOD诊断前1年个体体重指数（BMI）显著降低（P = 0.006）。
NOD与转移性和切除性PDAC患者较差的生存结果相关。在NOD诊断前BMI的降低，值得进一步研究以纳入PDAC筛查模式。
