, Volume 17, Issue 2, pp 502-513
Date: 03 Nov 2009

Preoperative Diabetes Mellitus and Long-Term Survival After Resection of Pancreatic Adenocarcinoma

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Abstract

Purpose

To assess clinicopathologic features and postresection survival of diabetes mellitus (DM)-associated pancreatic ductal adenocarcinoma (PDAC).

Methods

Records of resected PDAC patients from 2000 to 2007 were reviewed. DM was classified as new-onset (<24 months before PDAC) or longstanding (≥24 months). Clinicopathologic features were compared by univariate and multivariate analyses. Survival was assessed by Kaplan–Meier method and Cox regression.

Results

Of 209 patients, 93 (45%) met criteria for DM (35 longstanding DM, 55 new-onset DM, 3 duration unknown). DM patients were older (DM 66 ± 9 years, non-DM 63 ± 12 years, P = 0.06); a majority had additional preoperative comorbidities (DM 64.5%, non-DM 25.9%, P < 0.001). Tumor size was larger in patients with DM (DM 3.8 ± 1.7 cm, non-DM 3.2 ± 1.5 cm, P = 0.003). Groups were similar in terms of tumor location, perineural/lymphovascular invasion, and node and margin status. On logistic regression, tumor size ≥3.0 cm was independently associated with both overall DM (odds ratio [OR] 3.60; 95% confidence interval [1.79–7.26]) and new-onset DM (OR 3.69, [1.65–8.24]). Median survival was reduced in patients with DM compared with non-DM (15 versus 17 months, P = 0.015). Multivariate analysis controlling for prognostic variables including age, comorbidities, and tumor size demonstrated that DM was independently associated with reduced survival (hazard ratio [HR] 1.55, [1.02–2.35]). This association was more pronounced for patients with new-onset DM (HR 1.75 [1.10–2.78]) than those with longstanding DM (HR 1.30 [0.75–2.25]).

Conclusions

Preexisting DM is associated with reduced survival in patients undergoing resection for PDAC. PDAC with new-onset DM may exhibit increased tumor size and decreased postresection survival. Additional investigation is needed to clarify etiology and impact of PDAC-associated DM.