糖尿病是可切除胰腺导管腺癌的预后因子

Type 2 diabetes mellitus is a prognostic predictor in patients with resectable pancreatic ductal adenocarcinoma

目的:探讨合并2型糖尿病与胰腺导管腺癌(pancreatic ductal adenocarcinoma,PDAC)患者的临床病理因素及其与预后的关系。方法:回顾性分析2009年1月至2011年2月可手术切除PDAC患者的临床病理资料,进行生存分析。结果:136例PDAC患者中合并糖尿病的比率为27.9%,糖尿病与各临床病理特征均无关(均P>0.05)。单因素分析显示:糖尿病、肿瘤最大直径、组织学分化程度、pT分期、脉管侵润及pTNM分期,均与PDAC患者预后显著相关(均P<0.05)。多因素分析显示:合并糖尿病(HR,1.873;P=0.007),组织学低分化肿瘤(HR=2.647;P=0.002)及肿瘤最大直径≥4.0 cm(HR=1.699;P=0.018),均是独立预后因子。结论:合并糖尿病是可手术切除的PDAC患者预后差的独立预测因子。

Pancreatic ductal adenocarcinoma （PDAC） is one of the most aggressive and lethal human cancers. Current studies on the relationship between complicated type 2 diabetes mellitus （T2DM） and PDAC prognosis have demonstrated inconsistent results. The present study aimed to determine the relationship between complicated T2DM and the clinicopathological characteristics of PDAC, and evaluate whether complicated T2DM is a significant predictor for overall survival in patients with resectable PDAC. Methods： In this study, clinicopathological characteristics were observed in 136 patients who underwent surgery for PDAC at the Shengjing Hospital of China Medical University between January 2009 and February 2011. The relationship between complicated T2DM and overall survival of PDAC patients was analyzed using univariate and multivariate analyses. Results：The median age of patients was 60 years （range： 35-80 years）. Among the 136 patients, 76（55.9%） were male. The prevalence of complicated T2DM was 27.9%in 136 PDAC cases. Preexisting T2DM was not associated with any of the clinicopathological characteristics （all P〉0.05）. Univariate analysis showed that complicated T2DM （P=0.045）, maximum diameter （P=0.011）, histological differentiation （P=0.013）, pT stage （P=0.034）, vessel invasion （P=0.032）, and pTNM stage （P=0.030） were significantly associated with the overall survival of PDAC patients. The median overall survival time was 14.2 months for T2DM patients, and 18.8 months for non-T2DM patients. In multivariate analysis, complicated T2DM [hazard ratio （HR）, 1.873;95%confidence interval （CI）, 1.187-2.954;P=0.007], poorly differentiated tumor （HR, 2.647;95%CI, 1.413-4.957;P=0.002）, and maximum diameter≥4.0 cm （HR, 1.699;95%CI, 1.094-2.640;P=0.018） were the independent predictors associated with poor overall survival. Conclusion：Complicated T2DM was associated with poor prognosis. It could be used as a prognostic predictor in patients with resectable PDAC. If confirmed, these findings may provide a novel approach for individualized adjuvant therapy.